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General NPI Number Information
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NPI Number | 1861796997
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Entity Type | Organization
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Legal Business Name | DOUGLAS M. OSBORNE OD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/04/2011
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Last Update Date | 01/04/2011
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Provider Practice Location Address
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Address Line | 2910 JEFFERSON STREET SUITE 101
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City | CARLSBAD
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State | CA
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Zip | 92008-2357
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Country | US
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Telephone | 760-729-4327
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Fax | 760-729-4105
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Provider Business Mailing Address
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Address Line | 2910 JEFFERSON STREET SUITE 101
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City | CARLSBAD
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State | CA
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Zip | 92008-2357
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Country | US
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Telephone | 760-729-4327
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Fax | 760-729-4105
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Authorized Official
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Title or Position | OWNER
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Name | DR. DOUGLAS MITCHELL OSBORNE
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Credential | O.D.
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Telephone | 760-729-4327
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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 | 6526T
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License Number State | CA
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