MEDICARE: RANCHO SANTA FE OPTOMETRY APC

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	COR 1153	CA

General Provider Information

NPI Number	:	1922017896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANCHO SANTA FE OPTOMETRY APC

Provider Business Mailing Address
First Line	:	PO BOX 275
Second Line	:
City	:	RANCHO SANTA FE
State	:	CA
Zip	:	92067-0275
Country	:	US
Telephone Number	:	858-756-3210
Fax Number	:	858-756-3910

Provider Business Practice Location Address
First Line	:	6037 LA GRANADA
Second Line	:
City	:	RANCHO SANTA FE
State	:	CA
Zip	:	92067-0275
Country	:	US
Telephone Number	:	858-756-3210
Fax Number	:	858-756-3910

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SANDY PIERCE
Credential	:
Telephone Number	:	858-756-3210

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	09/01/2022

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