Provider Demographics
NPI:1952482820
Name:MURRIETA OPTOMETRY INC
Entity Type:Organization
Organization Name:MURRIETA OPTOMETRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:KAMENA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:925-443-3553
Mailing Address - Street 1:1171 MURRIETA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4143
Mailing Address - Country:US
Mailing Address - Phone:925-443-3553
Mailing Address - Fax:925-447-8500
Practice Address - Street 1:1171 MURRIETA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4143
Practice Address - Country:US
Practice Address - Phone:925-443-3553
Practice Address - Fax:925-447-8500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT11158TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ29748ZMedicare ID - Type Unspecified
CA5400930001Medicare NSC