Provider Demographics
NPI:1164466488
Name:KOLBERG OCULAR PRODUCTS, INC.
Entity Type:Organization
Organization Name:KOLBERG OCULAR PRODUCTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:I
Authorized Official - Last Name:KOLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:BCO
Authorized Official - Phone:858-695-2021
Mailing Address - Street 1:9663 TIERRA GRANDE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4568
Mailing Address - Country:US
Mailing Address - Phone:858-695-2021
Mailing Address - Fax:858-695-2712
Practice Address - Street 1:9663 TIERRA GRANDE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4568
Practice Address - Country:US
Practice Address - Phone:858-695-2021
Practice Address - Fax:858-695-2712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ33192ZMedicaid
CA0316430001Medicare NSC