Healthcare Provider Details

I. General information

NPI: 1619520061
Provider Name (Legal Business Name): LMT VISION CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 CLARES ST STE H
CAPITOLA CA
95010-2539
US

IV. Provider business mailing address

3555 CLARES ST STE H
CAPITOLA CA
95010-2539
US

V. Phone/Fax

Practice location:
  • Phone: 831-477-4900
  • Fax: 831-477-4900
Mailing address:
  • Phone: 831-477-4900
  • Fax: 408-477-4909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MR. FORD S TAKAICHI
Title or Position: CEO
Credential: ABO
Phone: 831-477-4900