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NPI Code Detail

MEDICARE: LIVE OPTICS, FAMILY BOUTIQUE

MEDICARE: LIVE OPTICS, FAMILY BOUTIQUE
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
1332H00000XEyewear SupplierD 6765CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285874685
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIVE OPTICS, FAMILY BOUTIQUE
Provider Business Mailing Address
First Line : 39159 PASEO PADRE PKWY STE 117
Second Line :
City : FREMONT
State : CA
Zip : 94538-1600
Country : US
Telephone Number : 510-494-8880
Fax Number : 510-494-8882
Provider Business Practice Location Address
First Line : 39159 PASEO PADRE PKWY STE 117
Second Line :
City : FREMONT
State : CA
Zip : 94538-1600
Country : US
Telephone Number : 510-494-8880
Fax Number : 510-494-8882
Authorized Official
Title or Position : CEO/ OPTICIAN
Name : EDITH C LIVELO
Credential : RDO
Telephone Number : 510-494-8880
Provider Enumeration Date : 02/24/2009
Last Update Date : 02/24/2009

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Directions to “LIVE OPTICS, FAMILY BOUTIQUE ” Practice Location

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