Organization
BROOKSIDE OPTOMETRIC GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG HISAKA O.D. (OWNER)
(209) 951-0820
Entity
Organization
Contact information
Practice address
3133 W MARCH LN STE 2020, STOCKTON, CA 95219-2361
(209) 951-0820
Mailing address
3133 W MARCH LN STE 2020, STOCKTON, CA 95219-2361
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0059260
—
CA
05
—
SD0094740
—
CA
05
—
SD0107720
—
CA
Enumeration date
03/28/2007
Last updated
08/06/2013
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