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General NPI Number Information
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NPI Number | 1528002201
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Entity Type | Organization
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Legal Business Name | MENDOCINO OPTICAL CO INC
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 08/12/2008
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Provider Practice Location Address
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Address Line | 280 S SCHOOL ST
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City | UKIAH
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State | CA
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Zip | 95482-4828
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Country | US
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Telephone | 707-462-2744
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Fax | 707-462-8789
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Provider Business Mailing Address
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Address Line | 280 S SCHOOL ST
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City | UKIAH
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State | CA
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Zip | 95482-4828
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Country | US
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Telephone | 707-462-2744
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Fax | 707-462-8789
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Authorized Official
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Title or Position | OWNER OPTICIAN
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Name | MRS. ANNE MARIE NIX
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Credential | LDO
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Telephone | 707-462-2744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 461
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License Number State | CA
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