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General NPI Number Information
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NPI Number | 1396836888
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Entity Type | Individual
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Provider Name | JEFFERY STANLEY NG O.D.
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Gender | Male
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7330 CLAIREMONT MESA BLVD STE 105
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City | SAN DIEGO
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State | CA
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Zip | 92111-1124
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Country | US
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Telephone | 858-292-0928
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Fax | 858-292-4498
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Provider Business Mailing Address
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Address Line | 9505 EASTER WAY #8
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City | SAN DIEGO
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State | CA
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Zip | 92121-1915
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Country | US
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Telephone | 619-916-6857
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 12737T
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License Number State | CA
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