Provider Demographics
NPI:1073620415
Name:NORTH BAY EYE ASSOCIATES A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:NORTH BAY EYE ASSOCIATES A MEDICAL CORPORATION
Other - Org Name:NORTH BAY EYE ASSOCIATES ASC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEE
Authorized Official - Middle Name:K
Authorized Official - Last Name:BRESLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-588-7946
Mailing Address - Street 1:PO BOX 11688
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95406-1688
Mailing Address - Country:US
Mailing Address - Phone:707-588-7939
Mailing Address - Fax:707-544-0808
Practice Address - Street 1:380 TESCONI CT
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4653
Practice Address - Country:US
Practice Address - Phone:707-544-3375
Practice Address - Fax:707-544-0808
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH BAY EYE ASSOCIATES A MEDICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110000297261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110000297OtherLICENSE