Provider Demographics
NPI:1386702553
Name:RALPH E SCHROCK OPTOMETRIC CORPORATION
Entity type:Organization
Organization Name:RALPH E SCHROCK OPTOMETRIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:VALENTI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:858-453-0442
Mailing Address - Street 1:8950 VILLA LA JOLLA DRIVE
Mailing Address - Street 2:B128
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1705
Mailing Address - Country:US
Mailing Address - Phone:858-453-0442
Mailing Address - Fax:858-453-5291
Practice Address - Street 1:8950 VILLA LA JOLLA DRIVE
Practice Address - Street 2:B128
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1705
Practice Address - Country:US
Practice Address - Phone:858-453-0442
Practice Address - Fax:858-453-5291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7608152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W0P7608AOtherMEDICARE PPIN PROVIDER GR
WY3327Medicare UPIN
W0P7608AOtherMEDICARE PPIN PROVIDER GR
WY3327Medicare PIN