Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPT 5370 TPA | CA |
N | 152WP0200X | Pediatric Optomitrist | OPT 5370 TPA | CA |
N | 152WS0006X | Sports Vision | OPT 5370 TPA | CA |
N | 152WX0102X | Occupational Vision | OPT 5370 TPA | CA |
N | 156FC0801X | Contact Lens Fitter | OPT 5370 TPA | CA |
NPI | 1942379664 |
---|---|
Provider Name | Dr. Thomas Cavanaugh |
First Address | Auburn, CA 95603-2463 |
Second Address | Auburn, CA 95603-2463 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 03/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T09965 | (02) | CA |