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General NPI Number Information
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NPI Number | 1710151790
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Entity Type | Organization
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Legal Business Name | DANVILLE OPTOMETRIC GROUP, INC.
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Dates
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Enumeration Date | 04/21/2008
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Last Update Date | 07/29/2009
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Provider Practice Location Address
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Address Line | 3464 CAMINO TASSAJARA
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City | DANVILLE
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State | CA
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Zip | 94506-4680
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Country | US
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Telephone | 925-736-4911
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Fax | 925-736-8272
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Provider Business Mailing Address
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Address Line | 3464 CAMINO TASSAJARA
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City | DANVILLE
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State | CA
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Zip | 94506-4680
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Country | US
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Telephone | 925-736-4911
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Fax | 925-736-8272
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Authorized Official
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Title or Position | OWNER
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Name | DR. PETER S VISENDI
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Credential | O.D.
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Telephone | 925-736-4911
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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 5475 TPA
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License Number State | CA
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