| |
1128 Galleria Blvd, Roseville, CA 95678-1992 | |
(916) 780-2020 | |
(561) 828-8367 |
Full Name | |
---|---|
Type | Facility |
Speciality | Eyewear Supplier |
Location | 1128 Galleria Blvd, Roseville, California |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1275848202 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 13774 (California) | Secondary |
332H00000X | Eyewear Supplier | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
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3801 S Congress Ave, Palm Springs, FL 33461-4140 Ph: (561) 275-2020 | 1128 Galleria Blvd, Roseville, CA 95678-1992 Ph: (916) 780-2020 |