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General NPI Number Information
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NPI Number | 1508451345
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Entity Type | Organization
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Legal Business Name | SIBAL OPTOMETRY, INC.
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Dates
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Enumeration Date | 03/03/2021
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 11990 LOS OSOS VALLEY RD
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-6861
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Country | US
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Telephone | 805-858-9914
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Fax |
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Provider Business Mailing Address
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Address Line | 11990 LOS OSOS VALLEY RD
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-6861
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Country | US
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Telephone | 805-858-9914
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARIAH SIBAL
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Credential | OD
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Telephone | 510-586-8476
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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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