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Organization
WOODCREST VISION CENTER
Active
Organization
WOODCREST VISION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER SHAW- MCMINN O.D. (OWNER/OPTOMETRIST)
(951) 780-0270
Entity
Organization
Contact information
Practice address
17675 VAN BUREN BLVD, SUITE C, RIVERSIDE, CA 92504-6076
(951) 780-0270
(951) 780-4807
Mailing address
17675 VAN BUREN BLVD, SUITE C, RIVERSIDE, CA 92504-6076
(951) 780-0270
(951) 780-4807
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT6553T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0065530
—
CA
Enumeration date
01/29/2008
Last updated
01/29/2008
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