Healthcare Provider Details

I. General information

NPI: 1083890693
Provider Name (Legal Business Name): NORTH BAY EYE ASSOCIATES, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 PRENTICE DR SUITE F
HEALDSBURG CA
95448-3384
US

IV. Provider business mailing address

PO BOX 11688
SANTA ROSA CA
95406-1688
US

V. Phone/Fax

Practice location:
  • Phone: 707-433-9475
  • Fax: 707-431-2013
Mailing address:
  • Phone: 707-588-7946
  • Fax: 707-588-7940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateCA

VIII. Authorized Official

Name: KIMBERLEE K BRESLIN
Title or Position: ACCOUNTS RECEIVABLE MANAGER
Credential:
Phone: 707-588-7946