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General NPI Number Information
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NPI Number | 1730253287
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Entity Type | Organization
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Legal Business Name | SACRAMENTO EYE CONSULTANTS A MED CORP
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 1515 RESPONSE RD
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City | SACRAMENTO
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State | CA
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Zip | 95815-4805
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Country | US
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Telephone | 916-649-1515
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Fax | 916-649-1516
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Provider Business Mailing Address
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Address Line | 1515 RESPONSE RD
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City | SACRAMENTO
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State | CA
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Zip | 95815-4805
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Country | US
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Telephone | 916-649-1515
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Fax | 916-649-1516
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Authorized Official
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Title or Position | PHYSICIAN
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Name | JACOB WELLINGTON BRUBAKER
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Credential | MD
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Telephone | 916-649-1515
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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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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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