=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134225840
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES E. TEARSE, M.D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2006
-----------------------------------------------------
Last Update Date | 08/19/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1391 WOODSIDE ROAD SUITE 200
-----------------------------------------------------
City | REDWOOD CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94061-3574
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-368-3937
-----------------------------------------------------
Fax | 650-368-0270
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1391 WOODSIDE ROAD SUITE 200
-----------------------------------------------------
City | REDWOOD CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94061-3574
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-368-3937
-----------------------------------------------------
Fax | 650-368-0270
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/OWNER
-----------------------------------------------------
Name | JAMES E. TEARSE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 650-368-3937
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | A42953
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------