Healthcare Provider Details

I. General information

NPI: 1194844837
Provider Name (Legal Business Name): SITE FOR SORE EYES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 CLARES ST STE H
CAPITOLA CA
95010-2555
US

IV. Provider business mailing address

3555 CLARES ST STE H
CAPITOLA CA
95010-2555
US

V. Phone/Fax

Practice location:
  • Phone: 831-477-4900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberD7055
License Number StateCA

VIII. Authorized Official

Name: ALEX SALMAN
Title or Position: OWNER
Credential:
Phone: 831-477-4900