Basic Information
| Provider Information | |||||||||
| NPI: | 1487624995 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STAPLES | ||||||||
| FirstName: | VERONICA | ||||||||
| MiddleName: | JULIE | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5253 ASPEN ST | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945687675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9254632150 | ||||||||
| FaxNumber: | 9254631186 | ||||||||
| Practice Location | |||||||||
| Address1: | 3901B SANTA RITA RD | ||||||||
| Address2: | |||||||||
| City: | PLEASANTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945883462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9254632150 | ||||||||
| FaxNumber: | 9254631186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2006 | ||||||||
| LastUpdateDate: | 07/11/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 9828TPL | CA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | SD0009280 | 05 | CA | MEDICAID |