1225040413 NPI number — DAVID W. MURIS SACRAMENTO VISIONCARE OPTOMETRIC CENTER

Table of content: DR. ERICA SARAH SPATZ M.D. (NPI 1720293186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225040413 NPI number — DAVID W. MURIS SACRAMENTO VISIONCARE OPTOMETRIC CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID W. MURIS SACRAMENTO VISIONCARE OPTOMETRIC CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225040413
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1111 HOWE AVE
Provider Second Line Business Mailing Address:
SUITE 235
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95825-8541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-929-9162
Provider Business Mailing Address Fax Number:
916-929-8837

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 HOWE AVE
Provider Second Line Business Practice Location Address:
SUITE 235
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95825-8541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-929-9162
Provider Business Practice Location Address Fax Number:
916-929-8837
Provider Enumeration Date:
08/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MURIS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
916-929-9162

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  FNP 2719 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GSD003150 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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