=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295889608
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MERVYN R. STEIN, M.D., A.P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 950 NORTHGATE DR SUITE 209
-----------------------------------------------------
City | SAN RAFAEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94903-3414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-479-2372
-----------------------------------------------------
Fax | 415-472-6225
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 950 NORTHGATE DR SUITE 209
-----------------------------------------------------
City | SAN RAFAEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94903-3414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-479-2372
-----------------------------------------------------
Fax | 415-472-6225
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MERVYN R STEIN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 415-479-2372
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 00G164240
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------