Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | G12588 | CA |
NPI | 1013002484 |
---|---|
Provider Name | Michael Eli Barricks |
First Address | Piedmont, CA 94611-3800 |
Second Address | Piedmont, CA 94611-3800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7348166 | RESOURCE NUMBER (01) | CA |