Provider Demographics
NPI:1902829336
Name:CORPUS, JOHN L (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:CORPUS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:118 AURORA WAY
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-2406
Mailing Address - Country:US
Mailing Address - Phone:510-691-3902
Mailing Address - Fax:
Practice Address - Street 1:1689 ARDEN WAY STE 1091
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4096
Practice Address - Country:US
Practice Address - Phone:916-929-5909
Practice Address - Fax:916-929-8202
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA13101152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist