Provider Demographics
NPI:1558530709
Name:JAMES S. LINVILLE, O.D.
Entity type:Organization
Organization Name:JAMES S. LINVILLE, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:LINVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:209-854-3771
Mailing Address - Street 1:579 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:GUSTINE
Mailing Address - State:CA
Mailing Address - Zip Code:95322-1143
Mailing Address - Country:US
Mailing Address - Phone:209-854-3771
Mailing Address - Fax:209-854-3772
Practice Address - Street 1:579 4TH AVE
Practice Address - Street 2:
Practice Address - City:GUSTINE
Practice Address - State:CA
Practice Address - Zip Code:95322-1143
Practice Address - Country:US
Practice Address - Phone:209-854-3771
Practice Address - Fax:209-854-3772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 8781 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT88745Medicare UPIN
0392350001Medicare NSC