Provider Demographics
NPI:1821024266
Name:D.R. OPTOMETRY
Entity type:Organization
Organization Name:D.R. OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:JOANITA
Authorized Official - Last Name:RADAKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:951-808-1080
Mailing Address - Street 1:1810 FULLERTON AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-3103
Mailing Address - Country:US
Mailing Address - Phone:951-808-1080
Mailing Address - Fax:951-808-1161
Practice Address - Street 1:1810 FULLERTON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3103
Practice Address - Country:US
Practice Address - Phone:951-808-1080
Practice Address - Fax:951-808-1161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty