Provider Demographics
NPI:1518453869
Name:GRIFFITH SAYLES OD, OPTOMETRY CORPORATION
Entity Type:Organization
Organization Name:GRIFFITH SAYLES OD, OPTOMETRY CORPORATION
Other - Org Name:PACIFIC VISION OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRIFFITH
Authorized Official - Middle Name:
Authorized Official - Last Name:SAYLES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:707-313-8019
Mailing Address - Street 1:1275 AIRPORT PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-7400
Mailing Address - Country:US
Mailing Address - Phone:707-313-8019
Mailing Address - Fax:
Practice Address - Street 1:1275 AIRPORT PARK BLVD.
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482
Practice Address - Country:US
Practice Address - Phone:206-370-1016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-10
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33605152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty