Organization
ENTERPRISE OPTOMETRY GROUP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA CALLAWAY (BILLING MANAGER)
(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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7781880001
DMERC PTAN
CA
01
—
CA408836
MEDICARE PTAN
CA
Enumeration date
09/17/2019
Last updated
10/15/2020
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