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General NPI Number Information
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NPI Number | 1578681524
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Entity Type | Individual
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Provider Name | BENJAMIN THRELKELD O.D.
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Gender | Male
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 399 SHERMAN AVE SUITE 11
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City | PALO ALTO
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State | CA
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Zip | 94306-1863
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Country | US
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Telephone | 650-323-6772
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Fax |
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Provider Business Mailing Address
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Address Line | 2901 TASMAN DR SUITE 208
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City | SANTA CLARA
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State | CA
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Zip | 95054-1136
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 11278T
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License Number State | CA
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