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BRIAN CALVERT O.D.

>> Optometrist >> Eye and Vision Services Providers

Registrant NPI Number: 1790778017

Individual Registrant:
 BRIAN  CALVERT O.D.
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

Contact information for business:
3429 RENNER DR  FORTUNA, CA 95540-3104 US
Tel: 707-725-5255  Fax: 707-725-8833

Registration Information:
NPI: 1790778017
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y152W00000XEye and Vision Services Providers
Optometrist
CA11045

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
SD0110451CA05




HEALTH CARE JOBS CA - Page 1



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