Healthcare Provider Details

I. General information

NPI: 1902945751
Provider Name (Legal Business Name): SIX RIVERS OPTICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2039 HARRISON AVE
EUREKA CA
95501-3211
US

IV. Provider business mailing address

2039 HARRISON AVE
EUREKA CA
95501-3211
US

V. Phone/Fax

Practice location:
  • Phone: 707-445-2079
  • Fax: 707-445-2070
Mailing address:
  • Phone: 707-445-2079
  • Fax: 707-445-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number2714
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number2714
License Number StateCA

VIII. Authorized Official

Name: MARTIN J DODD
Title or Position: OWNER
Credential: D.O.
Phone: 707-445-2079