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General NPI Number Information
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NPI Number | 1134515679
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Entity Type | Organization
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Legal Business Name | LAKE MERRITT OPTOMETRY
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Dates
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Enumeration Date | 04/11/2015
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Last Update Date | 04/11/2015
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Provider Practice Location Address
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Address Line | 1807 3RD AVE
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City | OAKLAND
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State | CA
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Zip | 94606-1803
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Country | US
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Telephone | 510-444-1969
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Fax |
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Provider Business Mailing Address
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Address Line | 1807 3RD AVE
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City | OAKLAND
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State | CA
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Zip | 94606-1803
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Country | US
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Telephone | 510-444-1969
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SERENE DAWN NGIN
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Credential | OD
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Telephone | 510-444-1969
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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 | 11844T
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License Number State | CA
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