| NPI | 1922442680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SASHA W BENTON Billing Specialist 530-758-2122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT 7215 TPA) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA CA13792TLG) |
| 152W00000X Optometrist (Licence: CA OPT 8488 TPA) | |
| 152W00000X Optometrist (Licence: CA OPT 15337 TLG) | |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2020-05-19 |