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General NPI Number Information
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NPI Number | 1629402565
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Entity Type | Organization
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Legal Business Name | GREGORY GEORGE HOM
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Dates
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Enumeration Date | 08/28/2013
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Last Update Date | 08/28/2013
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Provider Practice Location Address
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Address Line | 11230 SURRENTO VALLEY ROAD SUITE 145
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City | SAN DIEGO
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State | CA
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Zip | 92121
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Country | US
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Telephone | 858-535-9835
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Fax | 858-535-1266
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Provider Business Mailing Address
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Address Line | 11230 SURRENTO VALLEY ROAD SUITE 145
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City | SAN DIEGO
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State | CA
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Zip | 92121
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Country | US
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Telephone | 858-535-9835
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Fax | 858-535-1266
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Authorized Official
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Title or Position | OWNER
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Name | GREGORY HOM
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Credential |
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Telephone | 858-535-9835
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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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