MEDICARE: URBAN OPTIKS OPTOMETRY, INC

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

General Provider Information

NPI Number	:	1477315711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URBAN OPTIKS OPTOMETRY, INC

Provider Business Mailing Address
First Line	:	3788 PARK BLVD STE 5
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-0912
Country	:	US
Telephone Number	:	619-683-2020
Fax Number	:	619-683-2111

Provider Business Practice Location Address
First Line	:	3788 PARK BLVD STE 5
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-0912
Country	:	US
Telephone Number	:	619-683-2020
Fax Number	:	619-683-2111

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GARY A KLEIN
Credential	:	OD
Telephone Number	:	619-683-2020

Provider Enumeration Date	:	01/23/2024
Last Update Date	:	01/23/2024

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