Provider Demographics
NPI:1487898342
Name:NEGRI, DONALD THOMAS (OD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:THOMAS
Last Name:NEGRI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-3171
Mailing Address - Country:US
Mailing Address - Phone:559-875-5524
Mailing Address - Fax:559-875-9377
Practice Address - Street 1:1329 8TH ST
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-3171
Practice Address - Country:US
Practice Address - Phone:559-875-5524
Practice Address - Fax:559-875-9377
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 3950 TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD000180Medicaid
CAGSD000180Medicaid
CASD0039500Medicare PIN