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General NPI Number Information
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NPI Number | 1841325834
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Entity Type | Organization
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Legal Business Name | DEAN E FEWTRELL OD A PROFESSIONAL OPTOMETRIC CORPORATION
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 05/24/2018
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Provider Practice Location Address
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Address Line | 311 PAJARO ST
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City | SALINAS
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State | CA
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Zip | 93901-3421
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Country | US
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Telephone | 831-424-6201
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Fax | 831-757-4509
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Provider Business Mailing Address
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Address Line | 311 PAJARO STREET
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City | SALINAS
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State | CA
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Zip | 93901-3421
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Country | US
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Telephone | 831-424-6201
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Fax | 831-757-4509
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Authorized Official
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Title or Position | PRESIDENT OF CORPORATION
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Name | DR. DEAN E FEWTRELL
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Credential | OD
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Telephone | 831-424-6201
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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 | OPT7793T
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License Number State | CA
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