Healthcare Provider Details

I. General information

NPI: 1215062906
Provider Name (Legal Business Name): GOLDEN TRIANGLE OPTOMETRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25460 MEDICAL CENTER DR STE. 103
MURRIETA CA
92562-5985
US

IV. Provider business mailing address

25460 MEDICAL CENTER DR STE. 103
MURRIETA CA
92562-5985
US

V. Phone/Fax

Practice location:
  • Phone: 951-698-4575
  • Fax:
Mailing address:
  • Phone: 951-698-4575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7468T
License Number StateCA

VIII. Authorized Official

Name: MRS. JAN GELLER
Title or Position: DIRECTOR
Credential:
Phone: 951-698-4575