Provider Demographics
NPI:1780036103
Name:COMBS, SAMANTHA (OD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:COMBS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:VAVRICEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:410 PALLADIO PKWY
Mailing Address - Street 2:STE 1625
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-8829
Mailing Address - Country:US
Mailing Address - Phone:916-783-7696
Mailing Address - Fax:916-783-4199
Practice Address - Street 1:410 PALLADIO PKWY
Practice Address - Street 2:STE 1625
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-8829
Practice Address - Country:US
Practice Address - Phone:916-985-6399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-09
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33507152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist