Healthcare Provider Details

I. General information

NPI: 1508364530
Provider Name (Legal Business Name): CARPINTERIA EYE CARE CENTER OF OPTOMETRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 12/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 CASITAS PASS RD
CARPINTERIA CA
93013-2108
US

IV. Provider business mailing address

640 MAYRUM ST
SANTA BARBARA CA
93111-2719
US

V. Phone/Fax

Practice location:
  • Phone: 805-566-0306
  • Fax: 805-566-0307
Mailing address:
  • Phone: 805-566-0306
  • Fax: 805-566-0316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEVEN ROY KLEEN
Title or Position: PARTNER
Credential:
Phone: 909-792-3457