Healthcare Provider Details

I. General information

NPI: 1588962260
Provider Name (Legal Business Name): LINDA K HOLCROFT LICENSED OPTICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37398 BERKSHIRE DR STE C
MADERA CA
93636-8779
US

IV. Provider business mailing address

37398 BERKSHIRE DR STE C
MADERA CA
93636-8779
US

V. Phone/Fax

Practice location:
  • Phone: 559-645-4700
  • Fax: 559-645-4774
Mailing address:
  • Phone: 559-645-4700
  • Fax: 559-645-4774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License NumberCL926
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberSL2679
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: