Provider Demographics
NPI:1669658167
Name:MILLER & RANSBERGER ODS
Entity type:Organization
Organization Name:MILLER & RANSBERGER ODS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-592-3121
Mailing Address - Street 1:400 E PINE ST
Mailing Address - Street 2:P.O. BOX 367
Mailing Address - City:EXETER
Mailing Address - State:CA
Mailing Address - Zip Code:93221-1844
Mailing Address - Country:US
Mailing Address - Phone:559-592-3121
Mailing Address - Fax:559-592-3766
Practice Address - Street 1:400 E PINE ST
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:CA
Practice Address - Zip Code:93221-1844
Practice Address - Country:US
Practice Address - Phone:559-592-3121
Practice Address - Fax:559-592-3766
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILLER & RANSBERGER ODS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-14
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14924TLG152W00000X
CA5441TPG152W00000X
CA7283TPG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6563640Medicaid
CA4643714Medicaid
CA567276Medicaid
CA6276614Medicaid
CA567276Medicaid
CA4643714Medicaid
CABT208ZMedicare PIN
CABT122AMedicare PIN
CA6276614Medicaid
CA0386040001Medicare NSC