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NPI Code Detail

MEDICARE: MARSHALL B. KETCHUM UNIVERSITY

MEDICARE: MARSHALL B. KETCHUM UNIVERSITY
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
1152W00000XOptometrist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CP8428OTHERCARAILROAD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720101876
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARSHALL B. KETCHUM UNIVERSITY
Provider Business Mailing Address
First Line : 5460 E LA PALMA AVE
Second Line :
City : ANAHEIM
State : CA
Zip : 92807-2023
Country : US
Telephone Number : 714-463-7500
Fax Number : 714-992-7811
Provider Business Practice Location Address
First Line : 5460 E LA PALMA AVE
Second Line :
City : ANAHEIM
State : CA
Zip : 92807-2023
Country : US
Telephone Number : 714-463-7500
Fax Number : 714-992-7811
Authorized Official
Title or Position : ASSOCIATE DEAN OF CLINICS
Name : MARK NAKANO
Credential : O.D.
Telephone Number : 714-463-7504
Provider Enumeration Date : 04/06/2007
Last Update Date : 09/20/2016

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Directions to “MARSHALL B. KETCHUM UNIVERSITY ” Practice Location

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