Healthcare Provider Details

I. General information

NPI: 1669658167
Provider Name (Legal Business Name): MILLER & RANSBERGER ODS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 08/02/2023
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E PINE ST
EXETER CA
93221-1844
US

IV. Provider business mailing address

400 E PINE ST P.O. BOX 367
EXETER CA
93221-1844
US

V. Phone/Fax

Practice location:
  • Phone: 559-592-3121
  • Fax: 559-592-3766
Mailing address:
  • Phone: 559-592-3121
  • Fax: 559-592-3766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number14924TLG
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5441TPG
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7283TPG
License Number StateCA

VIII. Authorized Official

Name: PAULINA LOPEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 559-592-3121