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General NPI Number Information
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NPI Number | 1710105846
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Entity Type | Organization
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Legal Business Name | CLAREMONT OPTOMETRY GROUP
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/07/2014
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Provider Practice Location Address
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Address Line | 695 W FOOTHILL BLVD
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City | CLAREMONT
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State | CA
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Zip | 91711-3490
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Country | US
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Telephone | 909-625-7861
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Fax | 909-621-0742
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Provider Business Mailing Address
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Address Line | 695 W FOOTHILL BLVD
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City | CLAREMONT
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State | CA
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Zip | 91711-3490
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Country | US
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Telephone | 909-625-7861
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Fax | 909-621-0742
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Authorized Official
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Title or Position | PARTNER
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Name | DR. BRAD ANTHONY BAGGARLY
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Credential | O.D.
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Telephone | 909-625-7861
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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 | 9471-T
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License Number State | CA
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