Provider Demographics
NPI:1225016769
Name:MARIN OPHTHALMIC CONSULTANTS
Entity Type:Organization
Organization Name:MARIN OPHTHALMIC CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS REP
Authorized Official - Prefix:MS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-454-5565
Mailing Address - Street 1:901 E ST
Mailing Address - Street 2:SUITE 285
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2850
Mailing Address - Country:US
Mailing Address - Phone:415-454-5565
Mailing Address - Fax:415-454-2957
Practice Address - Street 1:165 ROWLAND WAY
Practice Address - Street 2:SUITE # 307
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5038
Practice Address - Country:US
Practice Address - Phone:415-454-5565
Practice Address - Fax:415-454-2957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC30889174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0015751Medicaid
CA=========OtherTAX ID
CAZZZ91585ZMedicare ID - Type Unspecified