1649200304 NPI number — ST FRANCIS OPHTHALMOLOGY GROUP

Table of content: (NPI 1649200304)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649200304 NPI number — ST FRANCIS OPHTHALMOLOGY GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST FRANCIS OPHTHALMOLOGY GROUP
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:
1649200304
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1440 SOUTHGATE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALY CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94015-2246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-992-1300
Provider Business Mailing Address Fax Number:
650-992-8391

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1440 SOUTHGATE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALY CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94015-2246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-992-1300
Provider Business Practice Location Address Fax Number:
650-992-8391
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARIN
Authorized Official First Name:
TRUDY
Authorized Official Middle Name:
K
Authorized Official Title or Position:
ACCOUNTS MANAGER
Authorized Official Telephone Number:
650-992-1300

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GR0066060 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ47199Z . This is a "BLUE SHIELD-SG" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DB7796 . This is a "RR MEDICARE/GROUP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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