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General NPI Number Information
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NPI Number | 1558828483
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Entity Type | Organization
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Legal Business Name | THRIVE EYES LLC
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Dates
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Enumeration Date | 02/27/2019
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Last Update Date | 02/27/2019
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Provider Practice Location Address
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Address Line | 100 S HARDING BLVD STE 100
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City | ROSEVILLE
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State | CA
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Zip | 95678-3360
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Country | US
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Telephone | 916-549-4839
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Fax | 916-783-8649
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Provider Business Mailing Address
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Address Line | 6280 WELLS AVE
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City | LOOMIS
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State | CA
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Zip | 95650-9341
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Country | US
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Telephone | 916-549-4838
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Fax | 916-783-8649
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Authorized Official
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Title or Position | OPTOMETRY
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Name | MR. ROMAN Y GOLAS
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Credential | O.D
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Telephone | 916-549-4838
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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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