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General NPI Number Information
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NPI Number | 1295706018
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Entity Type | Organization
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Legal Business Name | SAN RAMON OPTOMETRIC GROUP INC
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 01/29/2013
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Provider Practice Location Address
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Address Line | 2723 CROW CANYON RD # 102
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City | SAN RAMON
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State | CA
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Zip | 94583
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Country | US
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Telephone | 925-831-1084
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Fax | 925-831-8193
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Provider Business Mailing Address
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Address Line | 2723 CROW CANYON RD # 102
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City | SAN RAMON
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State | CA
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Zip | 94583
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Country | US
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Telephone | 925-831-1084
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Fax | 925-831-8193
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Authorized Official
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Title or Position | OWNER
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Name | FLETCHER H THAMES
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Credential | OD
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Telephone | 925-831-1084
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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 | 7590
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License Number State | CA
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