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Organization
DOUGLAS A LIDDICOAT INC
Active
Organization
DOUGLAS A LIDDICOAT INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS A LIDDICOAT MD (PRESIDENT)
(831) 728-2020
Entity
Organization
Contact information
Practice address
160 GREEN VALLEY RD, SUITE 202, FREEDOM, CA 95019-3160
(831) 728-2020
(831) 728-4739
Mailing address
160 GREEN VALLEY RD, SUITE 202, FREEDOM, CA 95019-3160
(831) 728-2020
(831) 728-4739
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
C19432
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OOC194320
—
CA
Enumeration date
06/01/2007
Last updated
08/22/2020
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