MEDICARE: EMILY H DO O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	8453T	CA

General Provider Information

NPI Number	:	1275552390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY H DO O.D.

Provider Business Mailing Address
First Line	:	2114 SENTER RD
Second Line	:	SUITE #6
City	:	SAN JOSE
State	:	CA
Zip	:	95112-2608
Country	:	US
Telephone Number	:	408-289-1448
Fax Number	:	408-289-1886

Provider Business Practice Location Address
First Line	:	2114 SENTER RD
Second Line	:	SUITE #6
City	:	SAN JOSE
State	:	CA
Zip	:	95112-2608
Country	:	US
Telephone Number	:	408-289-1448
Fax Number	:	408-289-1886

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	03/07/2012

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