=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174736169
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOCTORS OPTICAL SERVICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2007
-----------------------------------------------------
Last Update Date | 10/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 966 CASS ST STE 100
-----------------------------------------------------
City | MONTEREY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93940-4540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-373-0577
-----------------------------------------------------
Fax | 831-373-3164
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 966 CASS ST STE 100
-----------------------------------------------------
City | MONTEREY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93940-4540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-373-0577
-----------------------------------------------------
Fax | 831-373-3164
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTICIAN
-----------------------------------------------------
Name | MS. REGINA WILHELMINE PALMER
-----------------------------------------------------
Credential | ABOC
-----------------------------------------------------
Telephone | 831-373-0577
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------