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General NPI Number Information
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NPI Number | 1679862544
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Entity Type | Organization
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Legal Business Name | BLUE OAKS EYECARE INC
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Dates
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Enumeration Date | 03/31/2011
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Last Update Date | 12/07/2022
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Provider Practice Location Address
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Address Line | 1422 BLUE OAKS BLVD SUITE 150
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City | ROSEVILLE
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State | CA
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Zip | 95747-5196
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Country | US
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Telephone | 916-783-3937
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Fax | 916-783-3935
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Provider Business Mailing Address
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Address Line | 1422 BLUE OAKS BLVD SUITE 150
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City | ROSEVILLE
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State | CA
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Zip | 95747-5196
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Country | US
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Telephone | 916-783-3937
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Fax | 916-783-3935
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Authorized Official
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Title or Position | OWNER/PRESIDEN
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Name | DR. KRISTIE MY TRANG
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Credential | O.D.
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Telephone | 916-783-3937
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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 | 11441T
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License Number State | CA
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