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General NPI Number Information
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NPI Number | 1346050184
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Entity Type | Organization
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Legal Business Name | DR COURTNEY RAY PROFESSIONAL OPTOMETRIC CORPORATION
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 2033 SANTA ROSA PLZ
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City | SANTA ROSA
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State | CA
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Zip | 95401-6349
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Country | US
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Telephone | 707-544-0924
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Fax |
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Provider Business Mailing Address
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Address Line | 7542 TARA BLVD S
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City | SPANISH FORT
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State | AL
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Zip | 36527-5124
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Country | US
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Telephone | 831-535-3119
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | COURTNEY JEROME RAY
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Credential | MD
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Telephone | 831-535-3119
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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 |
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License Number State |
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