=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922215730
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DRS GRIFFITH AND HAMLET OPTOMETRISTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2007
-----------------------------------------------------
Last Update Date | 05/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 140 W HILLCREST DRIVE SUITE 112
-----------------------------------------------------
City | THOUSAND OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91360-4221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-497-6964
-----------------------------------------------------
Fax | 805-494-6836
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 140 W HILLCREST DRIVE SUITE 112
-----------------------------------------------------
City | THOUSAND OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91360-4221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-497-6964
-----------------------------------------------------
Fax | 805-494-6836
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST OWNER
-----------------------------------------------------
Name | DR. JASON C GRIFFITH
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 805-497-6964
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 11638T
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 11645T
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------