| |
3200 Sisk Rd, Modesto, CA 95356-0546 | |
(209) 577-3937 | |
(561) 828-8367 |
Full Name | |
---|---|
Type | Facility |
Speciality | Eyewear Supplier |
Location | 3200 Sisk Rd, Modesto, California |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1912212945 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 13686 (California) | Secondary |
332H00000X | Eyewear Supplier | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
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1615 S Congress Ave Ste 105, Delray Beach, FL 33445-6326 Ph: (561) 275-2020 | 3200 Sisk Rd, Modesto, CA 95356-0546 Ph: (209) 577-3937 |