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General NPI Number Information
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NPI Number | 1770774457
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Entity Type | Organization
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Legal Business Name | BIRD ROCK OPTICAL
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 03/03/2008
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Provider Practice Location Address
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Address Line | 865 3RD AVE STE 121
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City | CHULA VISTA
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State | CA
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Zip | 91911-1300
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Country | US
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Telephone | 619-427-2289
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Fax | 619-426-3427
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Provider Business Mailing Address
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Address Line | 865 3RD AVE STE 121
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City | CHULA VISTA
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State | CA
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Zip | 91911-1300
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Country | US
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Telephone | 619-427-2289
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Fax | 619-426-3427
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Authorized Official
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Title or Position | OWNER
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Name | MS. ELENA KRON
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Credential |
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Telephone | 619-427-2289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 021264-06
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License Number State | CA
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