| Ava Wallen, | |
|
3925 Old Redwood Hwy, Santa Rosa, CA 95403-1719 | |
| (707) 566-6060 | |
| Not Available |
| Full Name | Ava Wallen |
|---|---|
| Gender | Female |
| Speciality | Optometrist |
| Location | 3925 Old Redwood Hwy, Santa Rosa, California |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851033609 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | 35180 (California) | Primary |
| Provider Name | Permanente Medical Group Inc |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1073606299 PECOS PAC ID: 8921910225 Enrollment ID: O20031104000710 |
| Provider Name | Earle Baum Center Of The Blind Inc |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1013249986 PECOS PAC ID: 4486783636 Enrollment ID: O20100526000390 |
| Mailing Address | Practice Location Address |
|---|---|
| Ava Wallen, 3925 Old Redwood Hwy, Santa Rosa, CA 95403-1719 Ph: () - | Ava Wallen, 3925 Old Redwood Hwy, Santa Rosa, CA 95403-1719 Ph: (707) 566-6060 |
Sonoma Eyeworks Optometrist Medicare: Not Enrolled in Medicare Practice Location: 534 Larkfield Ctr, Santa Rosa, CA 95403 Phone: 707-578-4200 Fax: 707-578-5622 | |
Empire Eye Doctors Medical Group Inc Optometrist Medicare: Not Enrolled in Medicare Practice Location: 720 4th St, Santa Rosa, CA 95404 Phone: 707-575-3800 Fax: 707-528-4967 | |
Earle Baum Center Of The Blind Inc. Optometrist Medicare: Medicare Enrolled Practice Location: 4539 Occidental Rd, Santa Rosa, CA 95401 Phone: 707-523-3222 Fax: 707-636-2768 | |
Eos Eyecare Optometric Group Optometrist Medicare: Not Enrolled in Medicare Practice Location: 2655 Cleveland Ave Ste A, Santa Rosa, CA 95403 Phone: 707-542-8883 Fax: 707-546-7787 | |
Sterling Visioncare Optometrist Medicare: Not Enrolled in Medicare Practice Location: 2320 Midway Dr, Santa Rosa, CA 95405 Phone: 707-526-2020 Fax: 707-526-2032 | |
Lucille Hester Brongersma, O.D. Optometrist Medicare: Medicare Enrolled Practice Location: 3925 Old Redwood Hwy, Santa Rosa, CA 95403 Phone: 707-566-5297 | |
Dr. Shipley & Associates Optometrist Medicare: Not Enrolled in Medicare Practice Location: 1430 Guerneville Rd, Santa Rosa, CA 95403 Phone: 707-525-9920 Fax: 707-525-0844 |