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General NPI Number Information
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NPI Number | 1154207868
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Entity Type | Organization
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Legal Business Name | ECS OF BAY AREA NORTH OPTOMETRY CORPORATION
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Dates
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Enumeration Date | 08/15/2025
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 440 IGNACIO BLVD
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City | NOVATO
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State | CA
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Zip | 94949-6085
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Country | US
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Telephone | 618-462-9818
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Fax |
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Provider Business Mailing Address
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Address Line | 111 E 4TH ST STE 440
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City | ALTON
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State | IL
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Zip | 62002-6206
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Country | US
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Telephone | 618-462-9818
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Fax |
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Authorized Official
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Title or Position | SR. MANAGER MVC
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Name | SARA WERRIES
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Credential |
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Telephone | 972-370-5552
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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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