Healthcare Provider Details

I. General information

NPI: 1194525428
Provider Name (Legal Business Name): MARQUEE EYECARE CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 MIDWAY DR
SANTA ROSA CA
95405-5017
US

IV. Provider business mailing address

2320 MIDWAY DR
SANTA ROSA CA
95405-5017
US

V. Phone/Fax

Practice location:
  • Phone: 707-526-2020
  • Fax:
Mailing address:
  • Phone: 707-526-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MR. FELIX K KARANJA
Title or Position: PRESIDENT
Credential:
Phone: 707-526-2020