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Organization
EYE ASSOCIATES OF SEBASTOPOL MEDICAL GROUP INC
Active
Organization
EYE ASSOCIATES OF SEBASTOPOL MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIM KHAMTHEE (BILLING MANAGER)
(707) 823-0229
Entity
Organization
Contact information
Practice address
6880 PALM AVE, SEBASTOPOL, CA 95472-4270
(707) 823-7628
(707) 823-1521
Mailing address
6880 PALM AVE, SEBASTOPOL, CA 95472-4270
(707) 823-7628
(707) 823-1521
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
NULL
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D1077728
CLIA
CA
01
—
1247100001
DMERC
CA
01
—
CI4202
MEDICARE RET RAILROAD
CA
05
—
GR0083380
—
CA
05
—
GR0083381
—
CA
05
—
GR0083382
—
CA
05
—
GR0083383
—
CA
01
—
ZZZ16441Z
BLUE SHIELD
CA
01
—
ZZZ88771Z
BLUE SHIELD
CA
Enumeration date
09/06/2005
Last updated
09/01/2020
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