Provider Demographics
NPI:1629110861
Name:CALIFORNIA AVENUE OPTOMETRY & CONTACT LENS CLINIC
Entity Type:Organization
Organization Name:CALIFORNIA AVENUE OPTOMETRY & CONTACT LENS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST OWNER PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BAGGETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:650-617-2020
Mailing Address - Street 1:456 S CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1605
Mailing Address - Country:US
Mailing Address - Phone:650-617-2020
Mailing Address - Fax:650-617-4550
Practice Address - Street 1:456 S CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1605
Practice Address - Country:US
Practice Address - Phone:650-617-2020
Practice Address - Fax:650-617-4550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP 2950152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ27870ZMedicare PIN