=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194525428
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARQUEE EYECARE CENTERS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2025
-----------------------------------------------------
Last Update Date | 03/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2320 MIDWAY DR
-----------------------------------------------------
City | SANTA ROSA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95405-5017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-526-2020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2320 MIDWAY DR
-----------------------------------------------------
City | SANTA ROSA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95405-5017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-526-2020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. FELIX K KARANJA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 707-526-2020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------