Healthcare Provider Details

I. General information

NPI: 1063635936
Provider Name (Legal Business Name): EYEMAGINATION EYEWORKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 SERRAMONTE CTR
DALY CITY CA
94015-2345
US

IV. Provider business mailing address

69 SERRAMONTE CTR
DALY CITY CA
94015-2345
US

V. Phone/Fax

Practice location:
  • Phone: 650-992-8404
  • Fax: 650-992-6782
Mailing address:
  • Phone: 650-992-8404
  • Fax: 650-992-6782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6269
License Number StateCA

VIII. Authorized Official

Name: MS. NANCY ROBISON
Title or Position: MANAGER
Credential:
Phone: 650-992-8404