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General NPI Number Information
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NPI Number | 1689755605
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Entity Type | Individual
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Provider Name | HOWARD H ELLENBERGER OD, PHD
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Gender | Male
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 901 A ST SUITE C
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City | SAN RAFAEL
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State | CA
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Zip | 94901-3043
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Country | US
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Telephone | 415-453-8906
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Fax |
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Provider Business Mailing Address
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Address Line | 9 MOUNT WITTENBURG CT
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City | SAN RAFAEL
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State | CA
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Zip | 94903-1057
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Country | US
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Telephone | 415-492-8698
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OPT 13171 T
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License Number State | CA
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