Healthcare Provider Details

I. General information

NPI: 1487601522
Provider Name (Legal Business Name): SPECTRUM EYE PHYSICIANS, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 S DE ANZA BLVD SUITE A
CUPERTINO CA
95014-3030
US

IV. Provider business mailing address

10300 S DE ANZA BLVD SUITE A
CUPERTINO CA
95014-3030
US

V. Phone/Fax

Practice location:
  • Phone: 408-253-3083
  • Fax: 408-253-2965
Mailing address:
  • Phone: 408-253-3083
  • Fax: 408-253-2965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT 13831 TLG
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberSRYGH 97-67584700006
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. JOEL WILHELM
Title or Position: ADMINISTRATOR/CONTROLLER
Credential: COE
Phone: 408-252-7310