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General NPI Number Information
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NPI Number | 1902945751
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Entity Type | Organization
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Legal Business Name | SIX RIVERS OPTICAL, INC.
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2039 HARRISON AVE
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City | EUREKA
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State | CA
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Zip | 95501-3211
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Country | US
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Telephone | 707-445-2079
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Fax | 707-445-2070
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Provider Business Mailing Address
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Address Line | 2039 HARRISON AVE
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City | EUREKA
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State | CA
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Zip | 95501-3211
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Country | US
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Telephone | 707-445-2079
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Fax | 707-445-2070
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Authorized Official
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Title or Position | OWNER
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Name | MARTIN J DODD
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Credential | D.O.
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Telephone | 707-445-2079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 2714
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 2714
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License Number State | CA
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