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General NPI Number Information
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NPI Number | 1255342044
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Entity Type | Organization
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Legal Business Name | ROBERT M THEAKER O D AN OPTOMETRIC CORPORATION
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 09/17/2015
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Provider Practice Location Address
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Address Line | 365 6TH ST
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City | HOLLISTER
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State | CA
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Zip | 95023-3834
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Country | US
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Telephone | 831-637-5536
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Fax | 831-637-7601
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Provider Business Mailing Address
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Address Line | 365 6TH ST
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City | HOLLISTER
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State | CA
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Zip | 95023-3834
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Country | US
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Telephone | 831-637-5536
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Fax | 831-637-7601
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | NATALIE BOYER
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Credential |
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Telephone | 831-637-5536
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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 | FNP 2359
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License Number State | CA
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