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Eye and Vision Services Providers Optometrist

Provider NPI: 1952300238

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
45493 S FORK DR  THREE RIVERS, CA 93271-9318 US
Tel: 559-561-3204  Fax: --

Business Mailing Address:
45493 S FORK DR  THREE RIVERS, CA 93271-9318 US
Tel: 559-561-3204  Fax: --

NPI Information:
NPI: 1952300238
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y152W00000XEye and Vision Services Providers
N152WC0802XEye and Vision Services Providers
N152WL0500XEye and Vision Services Providers
N152WP0200XEye and Vision Services Providers

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 152W00000X





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