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General NPI Number Information
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NPI Number | 1588273833
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Entity Type | Organization
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Legal Business Name | FARTASH OD INC
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Dates
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Enumeration Date | 07/23/2020
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Last Update Date | 07/23/2020
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Provider Practice Location Address
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Address Line | 734 N MAIN ST
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City | CORONA
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State | CA
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Zip | 92880-1439
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Country | US
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Telephone | 951-737-2020
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Fax | 735-737-2072
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Provider Business Mailing Address
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Address Line | 734 N MAIN ST
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City | CORONA
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State | CA
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Zip | 92880-1439
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Country | US
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Telephone | 951-737-2020
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Fax | 735-737-2072
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | SHANNON DAVIS
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Credential |
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Telephone | 909-636-9920
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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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