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General NPI Number Information
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NPI Number | 1831369594
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Entity Type | Organization
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Legal Business Name | EAST BAY OPHTHALMIC ANESTHESIA INC
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Dates
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Enumeration Date | 03/08/2008
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 481 30TH ST
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City | OAKLAND
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State | CA
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Zip | 94609-3209
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Country | US
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Telephone | 510-835-4521
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Fax | 510-835-4223
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Provider Business Mailing Address
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Address Line | 210 N TUSTIN AVE
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City | SANTA ANA
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State | CA
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Zip | 92705-3807
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Country | US
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Telephone | 714-347-1010
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Fax | 714-647-1245
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Authorized Official
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Title or Position | SECRETARY-TREASURER
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Name | DR. WILLIAM ROBERT ROALFE
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Credential | M.D.
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Telephone | 510-835-4521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | FNP37950
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License Number State | CA
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