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General NPI Number Information
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NPI Number | 1003897075
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Entity Type | Individual
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Provider Name | JINTAU ERNEST TWO OP
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Gender | Male
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Dates
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Enumeration Date | 11/08/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 15888 MAIN ST #112A
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City | HESPERIA
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State | CA
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Zip | 92345-3452
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Country | US
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Telephone | 760-949-2242
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Fax | 760-949-3131
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Provider Business Mailing Address
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Address Line | 15888 MAIN ST #112A
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City | HESPERIA
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State | CA
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Zip | 92345-3452
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Country | US
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Telephone | 760-949-2242
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Fax | 760-949-3131
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | B606T
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License Number State | CA
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