Individual
DR. GEORGE MARIO WOLFUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
17149 CITRONIA ST, NORTHRIDGE, CA 91325-1931
(818) 341-1190
(818) 341-1190
Mailing address
17149 CITRONIA ST, NORTHRIDGE, CA 91325-1931
(818) 341-1190
(818) 341-1190
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4908T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SD0049080
BLUE SHIELD
CA
05
—
SD0049080
—
CA
Enumeration date
10/24/2005
Last updated
11/16/2012
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