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General NPI Number Information
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NPI Number | 1821024266
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Entity Type | Organization
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Legal Business Name | D.R. OPTOMETRY
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 08/22/2007
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Provider Practice Location Address
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Address Line | 1810 FULLERTON AVE SUITE 104
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City | CORONA
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State | CA
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Zip | 92881-3103
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Country | US
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Telephone | 951-808-1080
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Fax | 951-808-1161
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Provider Business Mailing Address
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Address Line | 1810 FULLERTON AVE SUITE 104
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City | CORONA
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State | CA
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Zip | 92881-3103
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Country | US
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Telephone | 951-808-1080
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Fax | 951-808-1161
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Authorized Official
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Title or Position | OWNER
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Name | DR. CATHERINE JOANITA RADAKOVIC
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Credential | O.D.
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Telephone | 951-808-1080
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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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