Healthcare Provider Details

I. General information

NPI: 1861839862
Provider Name (Legal Business Name): HMB OPTOMETRIC GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 CABRILLO HWY N SUITE J
HALF MOON BAY CA
94019-1650
US

IV. Provider business mailing address

393 EAGLE TRACE DR
HALF MOON BAY CA
94019-2291
US

V. Phone/Fax

Practice location:
  • Phone: 650-726-3937
  • Fax:
Mailing address:
  • Phone: 202-425-8663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13921
License Number StateCA

VIII. Authorized Official

Name: DR. NEDA MOSHASHA
Title or Position: OPTOMETRIST/PRESIDENT
Credential: OD
Phone: 202-425-8663