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General NPI Number Information
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NPI Number | 1891330171
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Entity Type | Organization
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Legal Business Name | SONOMA EYEWORKS AN OPTOMETRIC CORPORATION
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Dates
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Enumeration Date | 11/11/2019
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Last Update Date | 11/11/2019
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Provider Practice Location Address
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Address Line | 534 LARKFIELD CTR
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City | SANTA ROSA
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State | CA
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Zip | 95403-7503
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Country | US
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Telephone | 707-578-2020
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Fax | 707-578-5622
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Provider Business Mailing Address
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Address Line | 534 LARKFIELD CTR
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City | SANTA ROSA
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State | CA
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Zip | 95403-7503
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Country | US
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Telephone | 707-578-2020
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Fax | 707-578-5622
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Authorized Official
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Title or Position | CEO
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Name | DR. JEFFREY STEWART RICKS
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Credential | OD
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Telephone | 707-578-2020
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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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