Healthcare Provider Details

I. General information

NPI: 1447253919
Provider Name (Legal Business Name): MARIN OPHTHALMIC CONSULTANTS, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 04/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E ST STE 285
SAN RAFAEL CA
94901-2850
US

IV. Provider business mailing address

901 E ST STE 285
SAN RAFAEL CA
94901-2850
US

V. Phone/Fax

Practice location:
  • Phone: 415-454-5565
  • Fax: 415-454-2957
Mailing address:
  • Phone: 415-454-5565
  • Fax: 415-454-2957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number010589
License Number StateCA

VIII. Authorized Official

Name: MS. KRISTEN HODGES
Title or Position: ACCOUNTS RECEIVABLE MANAGER
Credential:
Phone: 415-454-5565