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General NPI Number Information
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NPI Number | 1811023724
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Entity Type | Organization
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Legal Business Name | ENTERPRISE OPTOMETRY GROUP
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 09/17/2019
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Provider Practice Location Address
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Address Line | 3080 VICTOR AVE
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City | REDDING
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State | CA
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Zip | 96002-1449
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Country | US
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Telephone | 530-222-3166
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Fax | 530-222-6539
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Provider Business Mailing Address
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Address Line | 3080 VICTOR AVE
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City | REDDING
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State | CA
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Zip | 96002-1449
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Country | US
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Telephone | 530-222-3166
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Fax | 530-222-6539
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Authorized Official
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Title or Position | INSURANCE SUPERVISOR
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Name | AMANDA CALLAWAY
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Credential |
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Telephone | 530-222-3166
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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 | 6443T
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License Number State | CA
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