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General NPI Number Information
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NPI Number | 1861829749
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Entity Type | Organization
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Legal Business Name | AUSTIN GREGORY
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Dates
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Enumeration Date | 10/08/2013
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Last Update Date | 10/08/2013
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Provider Practice Location Address
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Address Line | 2114 UNION ST APT A
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City | SAN FRANCISCO
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State | CA
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Zip | 94123-4004
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Country | US
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Telephone | 805-234-0528
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Fax |
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Provider Business Mailing Address
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Address Line | 2114 UNION ST APT A
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City | SAN FRANCISCO
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State | CA
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Zip | 94123-4004
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | AUSTIN THOMAS GREGORY
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Credential |
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Telephone | 805-234-0528
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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 | 14783
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License Number State | CA
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