Provider Demographics
NPI:1083890693
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, INC
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:707-588-7946
Mailing Address - Fax:707-588-7940
Practice Address - Street 1:1310 PRENTICE DR
Practice Address - Street 2:SUITE F
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3384
Practice Address - Country:US
Practice Address - Phone:707-433-9475
Practice Address - Fax:707-431-2013
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH BAY EYE ASSOCIATES, A MEDICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207W00000X
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ13802ZMedicare PIN
CA1104510002Medicare NSC