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General NPI Number Information
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NPI Number | 1649530536
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Entity Type | Organization
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Legal Business Name | TARAS LITVIN, O.D., INC.
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Dates
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Enumeration Date | 05/24/2012
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Last Update Date | 05/24/2012
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Provider Practice Location Address
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Address Line | 921 TRANSPORT WAY SUITE #18
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City | PETALUMA
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State | CA
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Zip | 94954-1461
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Country | US
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Telephone | 415-375-0042
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Fax |
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Provider Business Mailing Address
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Address Line | 921 TRANSPORT WAY SUITE #18
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City | PETALUMA
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State | CA
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Zip | 94954-1461
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Country | US
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Telephone | 415-375-0042
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. TARAS V. LITVIN
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Credential | O.D.
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Telephone | 510-557-9279
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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 | 13726TLG
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License Number State | CA
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