Organization
SANDRA DAVIDSON, O.D. INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SANDRA DAVIDSON O.D (OWNER)
(951) 784-2420
Entity
Organization
Contact information
Practice address
4515 CENTRAL AVE STE 101, RIVERSIDE, CA 92506-2374
(951) 784-2420
(951) 784-4713
Mailing address
4515 CENTRAL AVE STE 101, RIVERSIDE, CA 92506-2374
(951) 784-2420
(951) 784-4713
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD009191
—
CA
Enumeration date
07/25/2008
Last updated
10/15/2008
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