RETINA SPECIALISTS OF THE CENTRAL COAST INC
Medical Practice at California Blvd, San Luis Obispo, CA

License number
California C3049777
Category
Medical Practice
Type
Ophthalmology
Owner
Name: DEREK B. LAURITZEN M.D.
Title: PRESIDENT
Phone: (805) 547-2090
Address
Address
628 California Blvd SUITE C, San Luis Obispo, CA 93401
National Provider ID: 1821271248
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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RETINA SPECIALISTS OF THE CENTRAL COAST, INC

San Luis Obispo, CA

Registration:
Oct 3, 2007
Addresses:
628 Califonria Blvd #C, San Luis Obispo, CA 93401 (Physical)
628 California Blvd, San Luis Obispo, CA 93401
State ID:
C3049777
Business type:
Articles of Incorporation
President:
Steven C. Johnson (President)
Agent:
Steven C Johnson,San Luis Obispo, CA 93401 (Physical)

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