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General NPI Number Information
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NPI Number | 1851586523
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Entity Type | Organization
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Legal Business Name | PHYSICIANS NETWORK SERVICES MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 05/09/2008
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Provider Practice Location Address
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Address Line | 377 E CHAPMAN AVE STE 240
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City | PLACENTIA
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State | CA
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Zip | 92870-5091
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Country | US
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Telephone | 714-572-2039
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Fax |
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Provider Business Mailing Address
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Address Line | 377 E CHAPMAN AVE STE 240
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City | PLACENTIA
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State | CA
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Zip | 92870-5091
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Country | US
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Telephone | 714-572-2039
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | WILLIAM H TABB
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Credential | DPM
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Telephone | 714-572-2039
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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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