Provider Demographics
NPI:1952418378
Name:NORTH BAY EYE ASSOCIATES A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:NORTH BAY EYE ASSOCIATES A MEDICAL CORPORATION
Other - Org Name:NORTH BAY EYE ASSOCIATES, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:BARTLETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-544-3375
Mailing Address - Street 1:50 PROFESSIONAL CENTER DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2164
Mailing Address - Country:US
Mailing Address - Phone:707-588-7939
Mailing Address - Fax:707-588-7941
Practice Address - Street 1:50 PROFESSIONAL CENTER DR
Practice Address - Street 2:SUITE 210
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2164
Practice Address - Country:US
Practice Address - Phone:707-588-7939
Practice Address - Fax:707-588-7941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ51591ZOtherBS PETALUMA GROUP
CAGR0068570Medicaid
CAGR0068574Medicaid
CAZZZ61166ZOtherBS TESCONI COURT GROUP
CAGR0068572Medicaid
CAGR0068573Medicaid
CAZZZ51592ZOtherBS SANTA ROSA GROUP
CAZZZ55446ZOtherBS HEALDSBURG GROUP
CAGR0068571Medicaid
CAZZZ51592ZOtherBS SANTA ROSA GROUP
CA180024435Medicare ID - Type UnspecifiedRR SANTA ROSA
CA180025762Medicare ID - Type UnspecifiedRR PETALUMA
CAGR0068570Medicaid
CA180031307Medicare ID - Type UnspecifiedRR HEALDSBURG
CA180040232Medicare ID - Type UnspecifiedRR SONOMA
CAZZZ13802ZMedicare PIN
CAZZZ13801ZMedicare PIN