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General NPI Number Information
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NPI Number | 1003001439
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Entity Type | Organization
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Legal Business Name | REGENTS OF THE UNIVERSITY OF UC
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 04/01/2010
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Provider Practice Location Address
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Address Line | 9415 CAMPUS POINT DR
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City | LA JOLLA
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State | CA
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Zip | 92093
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Country | US
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Telephone | 858-450-6532
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Fax | 619-291-3937
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Provider Business Mailing Address
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Address Line | 9415 CAMPUS POINT DR
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City | LA JOLLA
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State | CA
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Zip | 92093
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Country | US
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Telephone | 858-450-6532
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Fax | 619-291-3937
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MR. MARK DAVID HANDMACHER
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Credential | OPTICIAN
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Telephone | 858-450-6532
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | D3439
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License Number State | CA
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