Provider Demographics
NPI:1194365023
Name:ARROYO GRANDE OPTOMETRY, INC.
Entity Type:Organization
Organization Name:ARROYO GRANDE OPTOMETRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WEITKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:805-489-8410
Mailing Address - Street 1:1118 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-2590
Mailing Address - Country:US
Mailing Address - Phone:805-489-8410
Mailing Address - Fax:805-233-6375
Practice Address - Street 1:1118 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-2590
Practice Address - Country:US
Practice Address - Phone:805-489-8410
Practice Address - Fax:805-233-6375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center