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General NPI Number Information
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NPI Number | 1073337457
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Entity Type | Organization
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Legal Business Name | CAMEN OPTOMETRY PC
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Dates
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Enumeration Date | 11/12/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 2195 STATION VILLAGE WAY STE B
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City | SAN DIEGO
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State | CA
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Zip | 92108-6569
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Country | US
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Telephone | 619-997-8081
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Fax |
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Provider Business Mailing Address
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Address Line | 2195 STATION VILLAGE WAY STE B
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City | SAN DIEGO
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State | CA
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Zip | 92108-6569
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Country | US
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Telephone | 619-997-8081
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JESSE CAMEN TROUT
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Credential |
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Telephone | 619-997-8081
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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 |
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License Number State |
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