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General NPI Number Information
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NPI Number | 1306853452
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Entity Type | Organization
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Legal Business Name | EYE MEDICAL CLINIC OF FRESNO, INC
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 11/24/2009
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Provider Practice Location Address
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Address Line | 1360 E HERNDON AVE SUITE 301
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City | FRESNO
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State | CA
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Zip | 93720-3326
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Country | US
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Telephone | 559-486-5000
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Fax | 559-439-7854
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Provider Business Mailing Address
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Address Line | 1360 E HERNDON AVE SUITE 301
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City | FRESNO
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State | CA
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Zip | 93720-3326
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Country | US
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Telephone | 559-486-5000
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Fax | 559-439-7854
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GEORGE A. BERTOLUCCI
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Credential | M.D.
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Telephone | 559-449-5097
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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 |
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License Number State |
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