MEDICARE: REDLANDS OPTOMETRY GROUP INC A PROFESSIONAL OPTOMETRIC 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	152W00000X	Optometrist	11183T	CA

General Provider Information

NPI Number	:	1467620062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDLANDS OPTOMETRY GROUP INC A PROFESSIONAL OPTOMETRIC CORPORATION

Provider Business Mailing Address
First Line	:	1020 NEVADA ST
Second Line	:	#202
City	:	REDLANDS
State	:	CA
Zip	:	92374-2956
Country	:	US
Telephone Number	:	909-793-2106
Fax Number	:	909-792-3246

Provider Business Practice Location Address
First Line	:	1020 NEVADA ST
Second Line	:	#202
City	:	REDLANDS
State	:	CA
Zip	:	92374-2956
Country	:	US
Telephone Number	:	909-793-2106
Fax Number	:	909-792-3246

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DARLENE KRISTINE MATEJKAMCMORRIS
Credential	:	O.D.
Telephone Number	:	909-793-2106

Provider Enumeration Date	:	02/15/2008
Last Update Date	:	02/05/2014

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