Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 10427T | CA |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 10427T | CA |
N | 152WP0200X | Pediatric Optomitrist | 10427T | CA |
N | 152WS0006X | Sports Vision | 10427T | CA |
N | 152WV0400X | Optomitrist - Vision Therapist | 10427T | CA |
NPI | 1124245568 |
---|---|
Provider Name | Gregory L Tom |
First Address | San Ramon, CA 94582 |
Second Address | San Ramon, CA 94582-5028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 24/08/2009 |