=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790996023
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DRS FARSON AND MURRAY, FAMILY EYECARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27724 SANTA MARGARITA PKWY
-----------------------------------------------------
City | MISSION VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92691-6653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-583-0422
-----------------------------------------------------
Fax | 949-583-0417
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27724 SANTA MARGARITA PKWY
-----------------------------------------------------
City | MISSION VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92691-6653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-583-0422
-----------------------------------------------------
Fax | 949-583-0417
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KEITH FARSON
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 949-583-0422
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 6913T
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------