Brookside Optometric Group

LBN: Brookside Optometric Group
Brookside Optometric Group is an health care organization with primary practice located at 3133 W March Ln Ste 2020 , Stockton CA 95219-2361. The organization recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as the primary health care specialty. Brookside Optometric Group can be contacted via phone (209) 951-0820, or through Hisaka, Craig via phone (209) 951-0820.

Contact Information

Primary practice address
3133 W March Ln Ste 2020 Stockton CA 95219-2361
Phone: (209) 951-0820
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Hisaka, Craig Doctor of Optometry (OD)
Phone: (209) 951-0820

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X

Profile Details

NPI number 1922127356
LBN Legal business name Brookside Optometric Group
DBA Doing business as
Authorized official Hisaka, Craig Doctor of Optometry (OD)
Entity Organization
Organization subpart 1 No
Enumeration date Mar 28th, 2007
Last updated Aug 6th, 2013 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922127356 NPPES
California MEDICAID SD0059260
California MEDICAID SD0094740
California MEDICAID SD0107720

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