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General NPI Number Information
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NPI Number | 1215062906
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Entity Type | Organization
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Legal Business Name | GOLDEN TRIANGLE OPTOMETRICS
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 25460 MEDICAL CENTER DR STE. 103
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City | MURRIETA
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State | CA
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Zip | 92562-5985
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Country | US
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Telephone | 951-698-4575
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Fax |
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Provider Business Mailing Address
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Address Line | 25460 MEDICAL CENTER DR STE. 103
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City | MURRIETA
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State | CA
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Zip | 92562-5985
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Country | US
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Telephone | 951-698-4575
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. JAN GELLER
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Credential |
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Telephone | 951-698-4575
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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 | 7468T
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License Number State | CA
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