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General NPI Number Information
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NPI Number | 1083075451
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Entity Type | Organization
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Legal Business Name | ARROWHEAD EYE ASSOCIATES INC
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Dates
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Enumeration Date | 03/14/2016
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Last Update Date | 03/14/2016
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Provider Practice Location Address
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Address Line | 10837 LAUREL ST 103
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-7643
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Country | US
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Telephone | 760-451-6412
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Fax |
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Provider Business Mailing Address
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Address Line | 10837 LAUREL ST 103
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-7643
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Country | US
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Telephone | 760-451-6412
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KRIS JOHN STORKERSEN
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Credential | MD
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Telephone | 909-213-6737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | G069270
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License Number State | CO
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