Provider Demographics
NPI:1912914482
Name:HORNE, JOSEPH R (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:R
Last Name:HORNE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:234 HEATHER CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-8765
Mailing Address - Country:US
Mailing Address - Phone:805-434-5970
Mailing Address - Fax:805-434-5973
Practice Address - Street 1:234 HEATHER CT
Practice Address - Street 2:SUITE 102
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-8765
Practice Address - Country:US
Practice Address - Phone:805-434-5970
Practice Address - Fax:805-434-5973
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT9479T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0094791Medicaid
CAWOP9479BMedicare ID - Type Unspecified
CAU49116Medicare UPIN
CASD0094791Medicaid
CA410047784Medicare ID - Type UnspecifiedRR MEDICARE