Provider Demographics
NPI:1174736169
Name:DOCTORS OPTICAL SERVICE
Entity type:Organization
Organization Name:DOCTORS OPTICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:WILHELMINE
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:831-373-0577
Mailing Address - Street 1:966 CASS ST
Mailing Address - Street 2:STE 100
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4540
Mailing Address - Country:US
Mailing Address - Phone:831-373-0577
Mailing Address - Fax:831-373-3164
Practice Address - Street 1:966 CASS ST
Practice Address - Street 2:STE 100
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4540
Practice Address - Country:US
Practice Address - Phone:831-373-0577
Practice Address - Fax:831-373-3164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6008560001Medicare NSC