Organization
EMPIRE EYE DOCTORS MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PENNY DOW (BILLING MANAGER)
(707) 575-3800
Entity
Organization
Contact information
Practice address
720 4TH ST, SANTA ROSA, CA 95404-4421
(707) 575-3800
(707) 528-4967
Mailing address
720 4TH ST, SANTA ROSA, CA 95404-4421
(707) 575-3800
(707) 528-4967
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
8739T
CA
152W00000X
Optometrist
T10471
CA
152WL0500X
Low Vision Rehabilitation Optometrist
8817T
CA
207W00000X
Ophthalmology Physician
G32019
CA
207W00000X
Ophthalmology Physician
Primary
G32243
CA
207W00000X
Ophthalmology Physician
G57122
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CP5395
RAILROAD MEDICARE
CA
05
—
GR0016130
—
CA
Enumeration date
10/21/2005
Last updated
05/01/2008
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