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General NPI Number Information
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NPI Number | 1538344742
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Entity Type | Organization
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Legal Business Name | NORTH BAY EYE ASSOCIATES, A MEDICAL CORPORATION
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 104 LYNCH CREEK WAY SUITE 15
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City | PETALUMA
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State | CA
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Zip | 94954-2355
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Country | US
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Telephone | 707-762-3573
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Fax | 707-762-6873
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Provider Business Mailing Address
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Address Line | PO BOX 11688
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City | SANTA ROSA
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State | CA
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Zip | 95406-1688
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Country | US
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Telephone | 707-588-7946
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Fax | 707-588-7940
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Authorized Official
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Title or Position | ACCOUNTS RECEIVABLE MANAGER
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Name | KIMBERLEE K BRESLIN
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Credential |
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Telephone | 707-588-7946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ZZZ42820Z
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License Number State | CA
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