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NPI Code Detail

MEDICARE: ST FRANCIS OPHTHALMOLOGY GROUP

MEDICARE: ST FRANCIS OPHTHALMOLOGY GROUP
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
1207W00000XOphthalmology Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3DB7796OTHERCARR MEDICARE/GROUP

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2ZZZ47199ZOTHERCABLUE SHIELD-SG

General Provider Information

NPI Number : 1649200304
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST FRANCIS OPHTHALMOLOGY GROUP
Provider Business Mailing Address
First Line : 1440 SOUTHGATE AVE
Second Line :
City : DALY CITY
State : CA
Zip : 94015-2246
Country : US
Telephone Number : 650-992-1300
Fax Number : 650-992-8391
Provider Business Practice Location Address
First Line : 1440 SOUTHGATE AVE
Second Line :
City : DALY CITY
State : CA
Zip : 94015-2246
Country : US
Telephone Number : 650-992-1300
Fax Number : 650-992-8391
Authorized Official
Title or Position : ACCOUNTS MANAGER
Name : MS. TRUDY K MARIN
Credential :
Telephone Number : 650-992-1300
Provider Enumeration Date : 07/05/2006
Last Update Date : 06/08/2010

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Directions to “ST FRANCIS OPHTHALMOLOGY GROUP ” Practice Location

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