Provider Demographics
NPI:1114941796
Name:CENTER FOR SIGHT OF STOCKTON A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CENTER FOR SIGHT OF STOCKTON A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:E
Authorized Official - Last Name:EDINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-948-5515
Mailing Address - Street 1:1899 W. MARCH LANE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6402
Mailing Address - Country:US
Mailing Address - Phone:209-623-4700
Mailing Address - Fax:209-623-4713
Practice Address - Street 1:612 W 11TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3855
Practice Address - Country:US
Practice Address - Phone:209-836-4800
Practice Address - Fax:209-836-3917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ26803ZOtherGROUP PTAN
CAZZZ26803ZMedicare PIN
CA1316090003Medicare NSC