Provider Demographics
NPI:1497027544
Name:AMEDCO CALIFORNIA INC
Entity Type:Organization
Organization Name:AMEDCO CALIFORNIA INC
Other - Org Name:OPTICAL WORLD INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GALEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAYSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-295-0001
Mailing Address - Street 1:1054 SANTA ROSA PLZ
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-6345
Mailing Address - Country:US
Mailing Address - Phone:707-544-3000
Mailing Address - Fax:707-544-7348
Practice Address - Street 1:1054 SANTA ROSA PLZ
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-6345
Practice Address - Country:US
Practice Address - Phone:707-544-3000
Practice Address - Fax:707-544-7348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty