Provider Demographics
NPI:1568448140
Name:MATEJKA MCMORRIS, DARLENE KRISTINE (OD)
Entity Type:Individual
Prefix:DR
First Name:DARLENE
Middle Name:KRISTINE
Last Name:MATEJKA MCMORRIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1478 INDUSTRIAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2892
Mailing Address - Country:US
Mailing Address - Phone:909-793-2106
Mailing Address - Fax:909-792-3246
Practice Address - Street 1:1478 INDUSTRIAL PARK AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2892
Practice Address - Country:US
Practice Address - Phone:909-793-2106
Practice Address - Fax:909-792-3246
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11183T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABV336ZMedicare PIN