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General NPI Number Information
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NPI Number | 1164590766
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Entity Type | Organization
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Legal Business Name | PRIMARY EYECARE CENTER AN OPTOMETRIC PRACTICE
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 04/27/2015
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Provider Practice Location Address
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Address Line | 7605 MORRO RD
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City | ATASCADERO
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State | CA
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Zip | 93422-4433
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Country | US
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Telephone | 805-466-3777
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Fax | 805-466-3700
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Provider Business Mailing Address
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Address Line | 7605 MORRO RD
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City | ATASCADERO
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State | CA
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Zip | 93422-4433
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Country | US
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Telephone | 805-466-3777
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Fax | 805-466-3700
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Authorized Official
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Title or Position | PARTNER OPTOMETRIST
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Name | DR. STEVEN SAGE HIDER
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Credential | O.D.
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Telephone | 805-466-3777
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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 | 10330
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License Number State | CA
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