MEDICARE: NORTH BAY EYE ASSOCIATES, A MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		CA
2	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1083890693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH BAY EYE ASSOCIATES, A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 11688
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95406-1688
Country	:	US
Telephone Number	:	707-588-7946
Fax Number	:	707-588-7940

Provider Business Practice Location Address
First Line	:	1310 PRENTICE DR
Second Line	:	SUITE F
City	:	HEALDSBURG
State	:	CA
Zip	:	95448-3384
Country	:	US
Telephone Number	:	707-433-9475
Fax Number	:	707-431-2013

Authorized Official
Title or Position	:	ACCOUNTS RECEIVABLE MANAGER
Name	:	KIMBERLEE K BRESLIN
Credential	:
Telephone Number	:	707-588-7946

Provider Enumeration Date	:	01/14/2008
Last Update Date	:	07/21/2022

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