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General NPI Number Information
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NPI Number | 1902488893
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Entity Type | Organization
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Legal Business Name | DRS. JOANNE AND TEM GRONQUIST, INC.
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Dates
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Enumeration Date | 04/21/2021
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Last Update Date | 04/27/2021
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Provider Practice Location Address
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Address Line | 1805 STATE ST STE B
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City | SANTA BARBARA
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State | CA
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Zip | 93101-8417
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Country | US
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Telephone | 805-569-1504
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Fax | 805-569-8707
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Provider Business Mailing Address
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Address Line | 1805 STATE ST STE B
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City | SANTA BARBARA
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State | CA
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Zip | 93101-8417
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Country | US
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Telephone | 805-569-1504
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Fax | 805-569-8707
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Authorized Official
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Title or Position | OPTOMETRIST/ OWNER
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Name | DR. JOANNE GRONQUIST
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Credential | OD
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Telephone | 805-569-1504
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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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