# DOUGLAS A LIDDICOAT INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831391937
- **Authorized official:** DOUGLAS A LIDDICOAT MD (PRESIDENT)
- **Authorized official phone:** (831) 728-2020

## Contact information

- **Practice address:** 160 GREEN VALLEY RD, SUITE 202, FREEDOM, CA 95019-3160
- **Practice address phone:** (831) 728-2020
- **Practice address fax:** (831) 728-4739
- **Mailing address:** 160 GREEN VALLEY RD, SUITE 202, FREEDOM, CA 95019-3160
- **Mailing address phone:** (831) 728-2020
- **Mailing address fax:** (831) 728-4739

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | C19432 | CA | Yes |

## Other

- **Enumeration date:** 06/01/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | OOC194320 | — | CA |