Provider Demographics
NPI:1003833856
Name:EYE SPECIALISTS MEDICAL GROUP OF NAPA VALLEY INC
Entity Type:Organization
Organization Name:EYE SPECIALISTS MEDICAL GROUP OF NAPA VALLEY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMESON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-255-6212
Mailing Address - Street 1:800 TRANCAS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3044
Mailing Address - Country:US
Mailing Address - Phone:707-255-6212
Mailing Address - Fax:707-255-6290
Practice Address - Street 1:800 TRANCAS ST
Practice Address - Street 2:SUITE A
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3044
Practice Address - Country:US
Practice Address - Phone:707-255-6212
Practice Address - Fax:707-255-6290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4404860001Medicare NSC
CAZZZ15166ZMedicare PIN