Provider Demographics
NPI:1679691638
Name:GEE & DOHERTY OPTOMETRY, P.C.
Entity Type:Organization
Organization Name:GEE & DOHERTY OPTOMETRY, P.C.
Other - Org Name:CONCORD OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:925-825-1090
Mailing Address - Street 1:5100 CLAYTON RD
Mailing Address - Street 2:SUITE D30
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-3139
Mailing Address - Country:US
Mailing Address - Phone:925-825-1090
Mailing Address - Fax:925-825-1095
Practice Address - Street 1:5100 CLAYTON RD
Practice Address - Street 2:SUITE D30
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-3139
Practice Address - Country:US
Practice Address - Phone:925-825-1090
Practice Address - Fax:925-825-1095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11126152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5957820001Medicare NSC
CAZZZ05870ZMedicare PIN