Healthcare Provider Details

I. General information

NPI: 1639832801
Provider Name (Legal Business Name): AAMUN GARCHA OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2021
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 SAINT MARKS PLZ STE D
STOCKTON CA
95207-6423
US

IV. Provider business mailing address

915 INTERLAKEN DR
LODI CA
95242-9173
US

V. Phone/Fax

Practice location:
  • Phone: 209-478-1797
  • Fax:
Mailing address:
  • Phone: 209-327-3577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35042TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: