Healthcare Provider Details

I. General information

NPI: 1326340845
Provider Name (Legal Business Name): AEVEN AMIR AWRAHA OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2010
Last Update Date: 12/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 E MAIN ST STE B
EL CAJON CA
92020-4008
US

IV. Provider business mailing address

528 E MAIN ST STE B
EL CAJON CA
92020-4008
US

V. Phone/Fax

Practice location:
  • Phone: 619-401-8845
  • Fax: 619-401-5381
Mailing address:
  • Phone: 619-401-8845
  • Fax: 619-401-5381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number017877
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: