Provider Demographics
NPI:1841634458
Name:DR. JOSEPH MALLORY'S OFFICE
Entity type:Organization
Organization Name:DR. JOSEPH MALLORY'S OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-375-9709
Mailing Address - Street 1:905 DRUMMOND AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3046
Mailing Address - Country:US
Mailing Address - Phone:760-446-5600
Mailing Address - Fax:760-650-9554
Practice Address - Street 1:905 DRUMMOND AVE
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3046
Practice Address - Country:US
Practice Address - Phone:760-446-5600
Practice Address - Fax:760-650-9554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty