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General NPI Number Information
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NPI Number | 1760939565
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Entity Type | Organization
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Legal Business Name | KATHLEEN MAI OD
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Dates
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Enumeration Date | 09/09/2016
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Last Update Date | 09/09/2016
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Provider Practice Location Address
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Address Line | 2111 FULKERTH RD
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City | TURLOCK
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State | CA
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Zip | 95380-9515
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Country | US
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Telephone | 209-634-8634
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Fax |
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Provider Business Mailing Address
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Address Line | 14603 MERCED ST
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City | SAN LEANDRO
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State | CA
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Zip | 94579-1058
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | KATHLEEN MAI
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Credential | OD
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Telephone | 510-388-7379
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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 | 14443
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License Number State | CA
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