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General NPI Number Information
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NPI Number | 1497854384
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Entity Type | Organization
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Legal Business Name | GRIFFIN OPTOMETRIC GROUP
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 07/02/2012
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Provider Practice Location Address
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Address Line | 140 AVENIDA DEL MAR
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-4016
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Country | US
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Telephone | 949-492-1853
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Fax |
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Provider Business Mailing Address
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Address Line | 30030 TOWN CENTER DR
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-2096
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Country | US
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Telephone | 949-495-3031
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TED POWERS GRIFFIN JR.
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Credential | OD
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Telephone | 949-495-3031
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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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