Provider Demographics
NPI:1023090693
Name:THORNTON, JULIE R (OD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:R
Last Name:THORNTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:576 N SUNRISE AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2841
Mailing Address - Country:US
Mailing Address - Phone:916-773-3937
Mailing Address - Fax:916-773-3936
Practice Address - Street 1:576 N SUNRISE AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2841
Practice Address - Country:US
Practice Address - Phone:916-773-3937
Practice Address - Fax:916-773-3936
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOP8600T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0086000Medicaid
CASD0086000Medicare ID - Type Unspecified
CASD0086000Medicaid
CA4171790001Medicare NSC