Provider Demographics
NPI:1023396355
Name:HERBERT, SAMUEL JOSEPH (OD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:JOSEPH
Last Name:HERBERT
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 1:1104 PEAR TREE LN
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6446
Mailing Address - Country:US
Mailing Address - Phone:707-252-5380
Mailing Address - Fax:707-252-5384
Practice Address - Street 1:1104 PEAR TREE LN
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6446
Practice Address - Country:US
Practice Address - Phone:707-252-5380
Practice Address - Fax:707-252-5384
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14187152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist