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General NPI Number Information
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NPI Number | 1295768919
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Entity Type | Organization
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Legal Business Name | NAPA VALLEY OPTOMETRIC GROUP
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 01/17/2021
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Provider Practice Location Address
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Address Line | 1104 PEAR TREE LN
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City | NAPA
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State | CA
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Zip | 94558-6446
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Country | US
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Telephone | 707-252-5380
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Fax | 707-252-5384
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Provider Business Mailing Address
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Address Line | 1104 PEAR TREE LN
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City | NAPA
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State | CA
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Zip | 94558-6446
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Country | US
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Telephone | 707-252-5380
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Fax | 707-252-5384
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | SAMUEL JOSEPH HERBERT
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Credential | OD
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Telephone | 707-252-5380
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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 | COR 731
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License Number State | CA
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