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General NPI Number Information
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NPI Number | 1255702767
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Entity Type | Organization
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Legal Business Name | SOLACE OPTOMETRY
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Dates
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Enumeration Date | 10/09/2015
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Last Update Date | 04/20/2016
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Provider Practice Location Address
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Address Line | 28039 SCOTT RD SUITE F
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City | MURRIETA
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State | CA
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Zip | 92563-7479
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Country | US
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Telephone | 951-301-3626
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Fax | 951-301-8970
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Provider Business Mailing Address
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Address Line | 28039 SCOTT RD SUITE F
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City | MURRIETA
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State | CA
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Zip | 92563-7479
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Country | US
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Telephone | 951-301-3626
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Fax | 951-301-8970
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JEREMIAH TAMPOYA
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Credential | O.D.
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Telephone | 951-296-7312
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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 | 13282
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License Number State | CA
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