Organization
EYE ASSOCIATES OF SEBASTOPOL MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIM KHAMTHEE (BILLING MANAGER)
(707) 823-0229
Entity
Organization
Contact information
Practice address
6880 PALM AVE, SEBASTOPOL, CA 95472-4270
(707) 823-7628
(707) 823-1521
Mailing address
6880 PALM AVE, SEBASTOPOL, CA 95472-4270
(707) 823-7628
(707) 823-1521
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D1077728
CLIA
CA
01
—
1247100001
DMERC
CA
01
—
CI4202
MEDICARE RET RAILROAD
CA
05
—
GR0083380
—
CA
05
—
GR0083381
—
CA
05
—
GR0083382
—
CA
05
—
GR0083383
—
CA
01
—
ZZZ16441Z
BLUE SHIELD
CA
01
—
ZZZ88771Z
BLUE SHIELD
CA
Enumeration date
09/06/2005
Last updated
09/01/2020
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