Healthcare Provider Details

I. General information

NPI: 1558739078
Provider Name (Legal Business Name): VILLA OPTOMETRY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 03/22/2026
Certification Date: 03/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 TELEGRAPH CANYON RD
CHULA VISTA CA
91910-6436
US

IV. Provider business mailing address

523 TELEGRAPH CANYON RD
CHULA VISTA CA
91910-6436
US

V. Phone/Fax

Practice location:
  • Phone: 619-482-2020
  • Fax: 619-482-2671
Mailing address:
  • Phone: 619-482-2020
  • Fax: 619-482-2671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10561 T
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number10561 T
License Number StateCA

VIII. Authorized Official

Name: DR. ANGELICA MARIE VILLA
Title or Position: CEO
Credential: O.D.
Phone: 858-260-9208