Organization
SHASTA EYE MEDICAL GROUP INC
Active
Other names
Larkspur Optometry
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GEORGE NEAL (ASSISTANT SECRETARY)
(844) 377-6468
Entity
Organization
Contact information
Practice address
3190 CHURN CREEK RD, REDDING, CA 96002-2122
(530) 223-2500
(530) 226-1375
Mailing address
PO BOX 398986, SAN FRANCISCO, CA 94139-5898
(530) 223-2500
(530) 226-1375
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0084930
—
CA
Enumeration date
09/13/2005
Last updated
02/17/2020
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