Provider Demographics
NPI:1558957589
Name:SKI RUN OPTOMETRY BY DR MALDONADO AND DR. LONDON
Entity Type:Organization
Organization Name:SKI RUN OPTOMETRY BY DR MALDONADO AND DR. LONDON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:530-544-3403
Mailing Address - Street 1:3637 LARCH AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:S LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-8478
Mailing Address - Country:US
Mailing Address - Phone:530-544-3403
Mailing Address - Fax:530-544-4032
Practice Address - Street 1:3637 LARCH AVE STE 2
Practice Address - Street 2:
Practice Address - City:S LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-8478
Practice Address - Country:US
Practice Address - Phone:530-544-3403
Practice Address - Fax:530-544-4032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty