Healthcare Provider Details

I. General information

NPI: 1003657545
Provider Name (Legal Business Name): ELOISA ANGUIANO MORFIN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 THROCKMORTON AVE
MILL VALLEY CA
94941-1919
US

IV. Provider business mailing address

1963 WILL O VIEW CIR
LAKEPORT CA
95453-3052
US

V. Phone/Fax

Practice location:
  • Phone: 415-388-8262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35742
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: