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BRIAN CALVERT O.D.
>> Optometrist >> Eye and Vision Services ProvidersRegistrant NPI Number: 1790778017
Individual Registrant: BRIAN CALVERT O.D.
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
3429 RENNER DR FORTUNA, CA 95540-3104 US
Tel: 707-725-5255 Fax: 707-725-8833
Tel: 707-725-5255 Fax: 707-725-8833
Contact information for business:
3429 RENNER DR FORTUNA, CA 95540-3104 US
Tel: 707-725-5255 Fax: 707-725-8833
Tel: 707-725-5255 Fax: 707-725-8833
Registration Information:
NPI: 1790778017
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 152W00000X | Eye and Vision Services Providers Optometrist | CA | 11045 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| SD0110451 | CA | 05 |
