Healthcare Provider Details

I. General information

NPI: 1396558334
Provider Name (Legal Business Name): EYEMKR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 BROADWAY ST STE 314
CHICO CA
95928-5345
US

IV. Provider business mailing address

341 BROADWAY ST STE 314
CHICO CA
95928-5345
US

V. Phone/Fax

Practice location:
  • Phone: 530-855-0783
  • Fax: 530-285-8553
Mailing address:
  • Phone: 530-855-0783
  • Fax: 530-285-8553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DYLAN COLE BOND
Title or Position: OCULARIST
Credential:
Phone: 530-855-0783