Provider Demographics
NPI:1831213990
Name:ROBERTS-EVANS, JOYCE ELLEN (OD)
Entity type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:ELLEN
Last Name:ROBERTS-EVANS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:JOYCE
Other - Middle Name:ELLEN
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1704 CHIANTI WAY
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-2233
Mailing Address - Country:US
Mailing Address - Phone:925-625-2507
Mailing Address - Fax:
Practice Address - Street 1:350 JOHN MUIR PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513
Practice Address - Country:US
Practice Address - Phone:925-634-6101
Practice Address - Fax:925-634-1308
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA07560T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASDOO 75600Medicare ID - Type Unspecified