Provider Demographics
NPI:1942215702
Name:FIG GARDEN OPTOMETRY, INC.
Entity Type:Organization
Organization Name:FIG GARDEN OPTOMETRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:KROHN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:559-229-7202
Mailing Address - Street 1:5151 N. PALM AVE.
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-2211
Mailing Address - Country:US
Mailing Address - Phone:559-229-7202
Mailing Address - Fax:559-229-2998
Practice Address - Street 1:5151 N. PALM AVE.
Practice Address - Street 2:SUITE 150
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-2211
Practice Address - Country:US
Practice Address - Phone:559-229-7202
Practice Address - Fax:559-229-2998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACOR 503152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD000470Medicaid
CA0373080001Medicare NSC
CAZZZ29971ZMedicare PIN