Provider Demographics
NPI:1922215730
Name:DRS GRIFFITH AND HAMLET OPTOMETRISTS
Entity Type:Organization
Organization Name:DRS GRIFFITH AND HAMLET OPTOMETRISTS
Other - Org Name:CONEJO FAMILY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:805-497-6964
Mailing Address - Street 1:140 W HILLCREST DRIVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-4221
Mailing Address - Country:US
Mailing Address - Phone:805-497-6964
Mailing Address - Fax:805-494-6836
Practice Address - Street 1:140 W HILLCREST DRIVE
Practice Address - Street 2:SUITE 112
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4221
Practice Address - Country:US
Practice Address - Phone:805-497-6964
Practice Address - Fax:805-494-6836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11638T152W00000X
CA11645T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1730167354OtherNPPES - NPI STACY J. HAMLET, OD
CA1154309789OtherNPPES - NPI JASON C. GRIFFITH, OD
CAU88161Medicare UPIN
CA1154309789OtherNPPES - NPI JASON C. GRIFFITH, OD
CAU88020Medicare UPIN