Provider Demographics
NPI:1588726491
Name:ST FRANCIS OPHTHALMOLOGY GROUP
Entity type:Organization
Organization Name:ST FRANCIS OPHTHALMOLOGY GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JERROLD
Authorized Official - Middle Name:C
Authorized Official - Last Name:BOCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-563-3900
Mailing Address - Street 1:2001 UNION ST STE 480
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-4128
Mailing Address - Country:US
Mailing Address - Phone:415-563-3900
Mailing Address - Fax:
Practice Address - Street 1:2001 UNION ST STE 480
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-4128
Practice Address - Country:US
Practice Address - Phone:415-563-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST FRANCIS OPHTHALMOLOGY GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-15
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA20794207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ47201ZOtherCA BLUE SHIELD
CAGR0066062Medicaid
CA00A207942Medicare ID - Type UnspecifiedMEDICARE
CAGR0066062Medicaid