Provider Demographics
NPI:1649317207
Name:PATRICIA EBRIGHT, O.D., INC
Entity type:Organization
Organization Name:PATRICIA EBRIGHT, O.D., INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EBRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-554-3101
Mailing Address - Street 1:127 HOSPITAL DR STE 201
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2500
Mailing Address - Country:US
Mailing Address - Phone:707-554-3101
Mailing Address - Fax:707-554-2402
Practice Address - Street 1:127 HOSPITAL DR STE 201
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2500
Practice Address - Country:US
Practice Address - Phone:707-554-3101
Practice Address - Fax:707-554-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4976 T152W00000X
CA10914 T152W00000X
CA10848 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05381ZMedicare PIN