Provider Demographics
NPI:1669738845
Name:BAKERSFIELD OPTOMETRIC GROUP
Entity type:Organization
Organization Name:BAKERSFIELD OPTOMETRIC GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:661-847-9870
Mailing Address - Street 1:11320 MING AVE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-1304
Mailing Address - Country:US
Mailing Address - Phone:661-847-9870
Mailing Address - Fax:661-847-9871
Practice Address - Street 1:11320 MING AVE
Practice Address - Street 2:SUITE 360
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-1304
Practice Address - Country:US
Practice Address - Phone:661-847-9870
Practice Address - Fax:661-847-9871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13064T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty