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General NPI Number Information
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NPI Number | 1154420602
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Entity Type | Organization
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Legal Business Name | GRIFFIN OPTOMETRIC TALEGA INC
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 06/01/2012
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Provider Practice Location Address
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Address Line | 1001 AVE PICO SUITE A
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-6956
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Country | US
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Telephone | 949-940-0200
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Fax | 949-940-0201
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Provider Business Mailing Address
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Address Line | 1001 AVE PICO SUITE A
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-6956
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Country | US
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Telephone | 949-940-0200
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Fax | 949-940-0201
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATRICK AUBURN GRIFFIN
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Credential | OD
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Telephone | 949-940-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 1154420602
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1154420602
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License Number State | CA
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