Provider Demographics
NPI:1326173725
Name:SAMPSON, GEOFFREY SCOT (OD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:SCOT
Last Name:SAMPSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1410 EVERETT AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1736
Mailing Address - Country:US
Mailing Address - Phone:707-745-6266
Mailing Address - Fax:707-745-1838
Practice Address - Street 1:874 SOUTHAMPTON RD
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-1907
Practice Address - Country:US
Practice Address - Phone:707-745-6266
Practice Address - Fax:707-745-1838
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 12000T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU78133Medicare UPIN