Organization
ENTERPRISE OPTOMETRY GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA CALLAWAY (INSURANCE SUPERVISOR)
(530) 222-3166
Entity
Organization
Contact information
Practice address
3080 VICTOR AVE, REDDING, CA 96002-1449
(530) 222-3166
(530) 222-6539
Mailing address
3080 VICTOR AVE, REDDING, CA 96002-1449
(530) 222-3166
(530) 222-6539
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
6443T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0064430
—
CA
01
—
ZZZ71464Y
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
02/26/2007
Last updated
09/17/2019
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