Provider Demographics
NPI:1164493466
Name:THORNTON, AARON DARRYL (OD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:DARRYL
Last Name:THORNTON
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 1:3417 FRUITVALE AVENUE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602
Mailing Address - Country:US
Mailing Address - Phone:510-530-2000
Mailing Address - Fax:510-530-2073
Practice Address - Street 1:3417 FRUITVALE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-2317
Practice Address - Country:US
Practice Address - Phone:510-530-2000
Practice Address - Fax:510-530-2073
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9630T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0096300Medicare PIN