Provider Demographics
NPI:1558354720
Name:LINVILLE, JAMES S (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:S
Last Name:LINVILLE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:579 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:GUSTINE
Mailing Address - State:CA
Mailing Address - Zip Code:95322-1143
Mailing Address - Country:US
Mailing Address - Phone:209-854-3771
Mailing Address - Fax:209-854-3772
Practice Address - Street 1:579 4TH AVE
Practice Address - Street 2:
Practice Address - City:GUSTINE
Practice Address - State:CA
Practice Address - Zip Code:95322-1143
Practice Address - Country:US
Practice Address - Phone:209-854-3771
Practice Address - Fax:209-854-3772
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 8781 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA77-022932OtherSUPPLEMENTAL INSURERS
CASD0087810OtherMEDICAL
SD0087810Medicare PIN
T88745Medicare UPIN