Provider Demographics
NPI:1629107172
Name:ACKROYD, ARCHIE MARTIN (OD)
Entity Type:Individual
Prefix:DR
First Name:ARCHIE
Middle Name:MARTIN
Last Name:ACKROYD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7246 CLAIREMONT MESA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1007
Mailing Address - Country:US
Mailing Address - Phone:858-292-7193
Mailing Address - Fax:858-292-8247
Practice Address - Street 1:7246 CLAIREMONT MESA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1007
Practice Address - Country:US
Practice Address - Phone:858-292-7193
Practice Address - Fax:858-292-8247
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4774T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist