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General NPI Number Information
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NPI Number | 1447253919
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Entity Type | Organization
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Legal Business Name | MARIN OPHTHALMIC CONSULTANTS, A MEDICAL CORPORATION
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 04/15/2013
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Provider Practice Location Address
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Address Line | 901 E ST STE 285
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City | SAN RAFAEL
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State | CA
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Zip | 94901-2850
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Country | US
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Telephone | 415-454-5565
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Fax | 415-454-2957
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Provider Business Mailing Address
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Address Line | 901 E ST STE 285
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City | SAN RAFAEL
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State | CA
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Zip | 94901-2850
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Country | US
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Telephone | 415-454-5565
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Fax | 415-454-2957
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Authorized Official
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Title or Position | ACCOUNTS RECEIVABLE MANAGER
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Name | MS. KRISTEN HODGES
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Credential |
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Telephone | 415-454-5565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 010589
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License Number State | CA
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