Provider Demographics
NPI:1871570945
Name:TAUNTON, PHILIP (OD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:TAUNTON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3002
Mailing Address - Country:US
Mailing Address - Phone:619-243-0629
Mailing Address - Fax:619-692-0229
Practice Address - Street 1:3939 3RD AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3002
Practice Address - Country:US
Practice Address - Phone:619-243-0629
Practice Address - Fax:619-692-0229
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10995T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13418Medicare ID - Type Unspecified
U94758Medicare UPIN