Provider Demographics
NPI:1649200304
Name:ST FRANCIS OPHTHALMOLOGY GROUP
Entity Type:Organization
Organization Name:ST FRANCIS OPHTHALMOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:MARIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-992-1300
Mailing Address - Street 1:1440 SOUTHGATE AVE
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2246
Mailing Address - Country:US
Mailing Address - Phone:650-992-1300
Mailing Address - Fax:650-992-8391
Practice Address - Street 1:1440 SOUTHGATE AVE
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2246
Practice Address - Country:US
Practice Address - Phone:650-992-1300
Practice Address - Fax:650-992-8391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0066060Medicaid
CAZZZ47199ZOtherBLUE SHIELD-SG
CADB7796OtherRR MEDICARE/GROUP
CA181725896Medicare ID - Type UnspecifiedJCBRRMEDICARE
CA020A60865Medicare PIN
CA180019436Medicare ID - Type UnspecifiedJSMRRMEDICARE
CA00A207945Medicare PIN
CAZZZ00142ZMedicare PIN
CAZZZ47199ZOtherBLUE SHIELD-SG
CA00A242995Medicare PIN
CAA23902Medicare UPIN
CAA22332Medicare UPIN
CA180004450Medicare ID - Type UnspecifiedBAMRRMEDICARE
CA0614000002Medicare NSC