| NPI | 1003806068 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PENNY DOW Billing Manager 707-575-3800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA G32243) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: CA G57122) |
| 207W00000X Ophthalmology (Licence: CA G32019) | |
| 152W00000X Optometrist (Licence: CA 8739T) | |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: CA 8817T) | |
| 152W00000X Optometrist (Licence: CA T10471) | |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2008-05-01 |