Healthcare Provider Details

I. General information

NPI: 1790316396
Provider Name (Legal Business Name): SAC EYE MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2020
Last Update Date: 02/01/2020
Certification Date: 02/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6444 COYLE AVE STE 1
CARMICHAEL CA
95608-0300
US

IV. Provider business mailing address

6444 COYLE AVE STE 1
CARMICHAEL CA
95608-0300
US

V. Phone/Fax

Practice location:
  • Phone: 310-962-3417
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNY CHOU
Title or Position: PRESIDENT
Credential: MD
Phone: 310-962-3417