Organization
PACIFIC VISION MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY A ENINGER M.D. (PARTNER)
(707) 465-2020
Entity
Organization
Contact information
Practice address
515 E WASHINGTON BLVD, CRESCENT CITY, CA 95531-8342
(707) 465-2020
(707) 465-6252
Mailing address
515 E WASHINGTON BLVD, CRESCENT CITY, CA 95531-8342
(707) 465-2020
(707) 465-6252
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
ZZZ28910Z
CA
207W00000X
Ophthalmology Physician
Primary
ZZZ28910Z
CA
332H00000X
Eyewear Supplier
0534820001
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0052190
—
CA
Enumeration date
01/09/2007
Last updated
06/29/2020
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