Provider Demographics
NPI:1891330171
Name:SONOMA EYEWORKS AN OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:SONOMA EYEWORKS AN OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:RICKS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:707-578-2020
Mailing Address - Street 1:534 LARKFIELD CTR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-7503
Mailing Address - Country:US
Mailing Address - Phone:707-578-2020
Mailing Address - Fax:707-578-5622
Practice Address - Street 1:534 LARKFIELD CTR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-7503
Practice Address - Country:US
Practice Address - Phone:707-578-2020
Practice Address - Fax:707-578-5622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty