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Organization
THREE RIVERS OPTOMETRIC GROUP INC
Active
Organization
THREE RIVERS OPTOMETRIC GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY R TAXERA OD (PRESIDENT)
(530) 674-5273
Entity
Organization
Contact information
Practice address
1245 THARP RD, YUBA CITY, CA 95993
(530) 674-5273
(530) 674-5275
Mailing address
1245 THARP RD, YUBA CITY, CA 95993
(530) 674-5273
(530) 674-5275
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
12712T
CA
152W00000X
Optometrist
7072T
CA
152W00000X
Optometrist
7125T
CA
152W00000X
Optometrist
COR949
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4598980001
MEDICARE CIGNA
CA
01
—
CK6935
RAILROAD MCARE
—
05
—
GSD004280
—
CA
01
—
ZZZ078052
BS
CA
Enumeration date
08/31/2006
Last updated
05/14/2024
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