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General NPI Number Information
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NPI Number | 1295887966
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Entity Type | Organization
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Legal Business Name | FARALLON EYE PHYSICIANS CORP
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 05/17/2023
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Provider Practice Location Address
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Address Line | 1850 SULLIVAN AVE STE 500
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City | DALY CITY
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State | CA
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Zip | 94015-2215
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Country | US
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Telephone | 650-992-9221
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Fax |
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Provider Business Mailing Address
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Address Line | 1850 SULLIVAN AVE STE 500
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City | DALY CITY
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State | CA
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Zip | 94015-2221
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Country | US
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Telephone | 650-992-9221
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUSAN LONGAR
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Credential | MD
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Telephone | 650-992-9221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | G75139
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License Number State | CA
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