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General NPI Number Information
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NPI Number | 1629110861
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Entity Type | Organization
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Legal Business Name | CALIFORNIA AVENUE OPTOMETRY & CONTACT LENS CLINIC
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 456 S CALIFORNIA AVE
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City | PALO ALTO
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State | CA
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Zip | 94306-1605
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Country | US
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Telephone | 650-617-2020
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Fax | 650-617-4550
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Provider Business Mailing Address
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Address Line | 456 S CALIFORNIA AVE
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City | PALO ALTO
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State | CA
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Zip | 94306-1605
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Country | US
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Telephone | 650-617-2020
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Fax | 650-617-4550
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Authorized Official
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Title or Position | OPTOMETRIST OWNER PARTNER
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Name | DR. DAN ALAN BAGGETT
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Credential | O.D.
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Telephone | 650-617-2020
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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 | FNP 2950
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License Number State | CA
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