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General NPI Number Information
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NPI Number | 1003256678
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Entity Type | Organization
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Legal Business Name | NORTH BAY EYE ASSOCIATES, INC
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Dates
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Enumeration Date | 06/27/2013
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Last Update Date | 06/27/2013
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Provider Practice Location Address
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Address Line | 225 S MAIN ST
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City | LAKEPORT
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State | CA
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Zip | 95453-5018
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Country | US
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Telephone | 707-588-9179
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Fax | 707-588-7941
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Provider Business Mailing Address
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Address Line | PO BOX 11688
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City | SANTA ROSA
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State | CA
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Zip | 95406-1688
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Country | US
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Telephone | 707-588-9179
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Fax | 707-588-7941
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Authorized Official
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Title or Position | ASSISTANT ADMINISTRATOR
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Name | DIANA ARREGUIN
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Credential |
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Telephone | 707-588-9179
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT7408TSA
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License Number State | CA
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