MEDICARE: AUBURN FAMILY OPTOMETRY, INC.

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	OPT 8316 TPA	CA

General Provider Information

NPI Number	:	1710063730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUBURN FAMILY OPTOMETRY, INC.

Provider Business Mailing Address
First Line	:	3133 PROFESSIONAL DRIVE
Second Line	:	SUITE 14
City	:	AUBURN
State	:	CA
Zip	:	95603
Country	:	US
Telephone Number	:	530-888-0670
Fax Number	:	530-888-8652

Provider Business Practice Location Address
First Line	:	3133 PROFESSIONAL DR
Second Line	:	SUITE 14
City	:	AUBURN
State	:	CA
Zip	:	95603-2463
Country	:	US
Telephone Number	:	530-888-0670
Fax Number	:	530-888-8652

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEFFREY VERNE ALLGEIER
Credential	:	O.D.
Telephone Number	:	530-888-0670

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	04/06/2011

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