Organization
BARTON M PEDERSEN O.D. AN OPTOMETRIC CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BARTON M. PEDERSEN O.D. (OWNER)
(760) 228-2020
Entity
Organization
Contact information
Practice address
56970 YUCCA TRL # S-101, YUCCA VALLEY, CA 92284-3753
(760) 228-2020
(760) 369-2020
Mailing address
56970 YUCCA TRL # S-101, YUCCA VALLEY, CA 92284-3753
(760) 228-2020
(760) 369-2020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT4600T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043294929
RONALD Y. HAYASHIDA, O.D.
CA
01
—
1124224589
GROUP NPI
CA
01
—
1134103484
DENNIS G. LOWMAN O.D.
CA
01
—
1215911565
CHARLES J. BAUS, O.D.
CA
01
—
1336123686
BARTON M. PEDERSEN, O.D.
CA
01
—
410004661
RAILROAD MEDICARE
CA
05
—
SD0045740
—
CA
05
—
SD0046000
—
CA
05
—
SD0121830
—
CA
01
—
ZZZ696612
BLUE SHIELD
CA
Enumeration date
06/22/2007
Last updated
02/25/2010
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