Healthcare Provider Details

I. General information

NPI: 1497854384
Provider Name (Legal Business Name): GRIFFIN OPTOMETRIC GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 AVENIDA DEL MAR
SAN CLEMENTE CA
92672-4016
US

IV. Provider business mailing address

30030 TOWN CENTER DR
LAGUNA NIGUEL CA
92677-2096
US

V. Phone/Fax

Practice location:
  • Phone: 949-492-1853
  • Fax:
Mailing address:
  • Phone: 949-495-3031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. TED POWERS GRIFFIN JR.
Title or Position: OWNER
Credential: OD
Phone: 949-495-3031