Provider Demographics
NPI:1760532659
Name:ROCKRIDGE OPTOMETRY
Entity Type:Organization
Organization Name:ROCKRIDGE OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SARVER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-655-3797
Mailing Address - Street 1:5321 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1416
Mailing Address - Country:US
Mailing Address - Phone:510-655-3797
Mailing Address - Fax:510-655-3701
Practice Address - Street 1:5321 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1416
Practice Address - Country:US
Practice Address - Phone:510-655-3797
Practice Address - Fax:510-655-3701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24310ZMedicare PIN
CA0292020001Medicare NSC