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General NPI Number Information
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NPI Number | 1487904868
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Entity Type | Organization
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Legal Business Name | FAMILY EYE CARE OF INDIAN WELLS
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Dates
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Enumeration Date | 09/13/2012
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Last Update Date | 09/13/2012
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Provider Practice Location Address
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Address Line | 74785 US HIGHWAY 111 #207
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City | INDIAN WELLS
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State | CA
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Zip | 92210-7107
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Country | US
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Telephone | 760-340-5292
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Fax | 760-773-5082
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Provider Business Mailing Address
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Address Line | 74785 US HIGHWAY 111 #207
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City | INDIAN WELLS
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State | CA
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Zip | 92210-7107
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Country | US
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Telephone | 760-340-5292
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Fax | 760-773-5082
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Authorized Official
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Title or Position | OWNER
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Name | DR. GORDON F BATEMAN
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Credential | O.D.
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Telephone | 760-340-5292
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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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