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General NPI Number Information
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NPI Number | 1689276651
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Entity Type | Organization
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Legal Business Name | IN DEPTH VISION OPTOMETRY PC
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Dates
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Enumeration Date | 11/13/2020
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Last Update Date | 11/13/2020
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Provider Practice Location Address
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Address Line | 3262 FORTUNE CT
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City | AUBURN
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State | CA
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Zip | 95602-7847
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Country | US
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Telephone | 530-830-7007
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Fax |
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Provider Business Mailing Address
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Address Line | 3262 FORTUNE CT
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City | AUBURN
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State | CA
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Zip | 95602-7847
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Country | US
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Telephone | 530-830-7007
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. CORINNE ODINEAL
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Credential | OD
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Telephone | 530-300-9379
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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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