Healthcare Provider Details

I. General information

NPI: 1134309222
Provider Name (Legal Business Name): CARL A BOECK & RONALD W SCHISLER PTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9621 MISSION GORGE RD 106
SANTEE CA
92071-3802
US

IV. Provider business mailing address

9621 MISSION GORGE RD 106
SANTEE CA
92071-3802
US

V. Phone/Fax

Practice location:
  • Phone: 619-449-2000
  • Fax:
Mailing address:
  • Phone: 619-449-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT6791T-G
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT6620T
License Number StateCA

VIII. Authorized Official

Name: DR. CARL ALLEN BOECK
Title or Position: PARTNER/OWNER
Credential: O.D.
Phone: 619-449-2000