Healthcare Provider Details

I. General information

NPI: 1811654213
Provider Name (Legal Business Name): EYES OF CONCORD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 SUNVALLEY BLVD STE 110
CONCORD CA
94520-5816
US

IV. Provider business mailing address

901 SUNVALLEY BLVD STE 110
CONCORD CA
94520-5816
US

V. Phone/Fax

Practice location:
  • Phone: 925-676-5638
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS SHASHATI
Title or Position: DIRECTOR
Credential:
Phone: 858-414-3513