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Organization
SHASTA EYE MEDICAL GROUP INC
Active
Organization
SHASTA EYE MEDICAL GROUP INC
Active
Other names
Larkspur Optometry
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GEORGE NEAL (ASSISTANT SECRETARY)
(844) 377-6468
Entity
Organization
Contact information
Practice address
3190 CHURN CREEK RD, REDDING, CA 96002-2122
(530) 223-2500
(530) 226-1375
Mailing address
PO BOX 398986, SAN FRANCISCO, CA 94139-5898
(530) 223-2500
(530) 226-1375
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
NULL
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
NULL
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Enumeration date
09/13/2005
Last updated
02/17/2020
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