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General NPI Number Information
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NPI Number | 1609478189
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Entity Type | Organization
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Legal Business Name | DINUBA OPTOMETRIC CENTER INC A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 11/10/2020
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Last Update Date | 03/18/2021
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Provider Practice Location Address
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Address Line | 119 S L ST
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City | DINUBA
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State | CA
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Zip | 93618-2324
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Country | US
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Telephone | 559-591-4656
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Fax | 559-591-4090
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Provider Business Mailing Address
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Address Line | 4384 E ASHLAN AVE STE 107
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City | FRESNO
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State | CA
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Zip | 93726-2600
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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 | SOLE OWNER / PRESIDENT
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Name | MOSES THAI
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Credential | OD
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Telephone | 909-694-9446
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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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