Organization
FARTASH OD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON DAVIS (CREDENTIALING SPECIALIST)
(909) 636-9920
Entity
Organization
Contact information
Practice address
734 N MAIN ST, CORONA, CA 92880-1439
(951) 737-2020
(735) 737-2072
Mailing address
734 N MAIN ST, CORONA, CA 92880-1439
(951) 737-2020
(735) 737-2072
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417263500
—
CA
Enumeration date
07/23/2020
Last updated
07/23/2020
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