Provider Demographics
NPI:1235356437
Name:TOPA TOPA OPTOMETRY, INC
Entity Type:Organization
Organization Name:TOPA TOPA OPTOMETRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:CALVIN
Authorized Official - Last Name:BROCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:805-646-5109
Mailing Address - Street 1:1211 MARICOPA HWY
Mailing Address - Street 2:STE 101
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023
Mailing Address - Country:US
Mailing Address - Phone:805-646-5109
Mailing Address - Fax:805-646-3519
Practice Address - Street 1:1211 MARICOPA HWY
Practice Address - Street 2:STE. 101
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023
Practice Address - Country:US
Practice Address - Phone:805-646-5109
Practice Address - Fax:805-646-3519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD004010Medicaid
CAWY147Medicare PIN
CAT70238FMedicare UPIN
CADO2363Medicare PIN
CAGSD004010Medicaid