Individual
DUANE THOMAS BROOKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
110 CHESTNUT ST, MOUNT SHASTA, CA 96067-2209
(530) 926-2033
(530) 926-3722
Mailing address
110 CHESTNUT ST, MOUNT SHASTA, CA 96067-2209
(530) 926-2033
(530) 926-3722
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5366T
CA
152W00000X
Optometrist
777T
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0053660
—
CA
Enumeration date
05/23/2005
Last updated
11/28/2007
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