Healthcare Provider Details

I. General information

NPI: 1699362053
Provider Name (Legal Business Name): URBAN EYEWEAR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2020
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8843 VILLA LA JOLLA DR STE 201
LA JOLLA CA
92037-1964
US

IV. Provider business mailing address

2266 JUAN ST
SAN DIEGO CA
92103-1159
US

V. Phone/Fax

Practice location:
  • Phone: 619-539-7279
  • Fax: 619-310-6956
Mailing address:
  • Phone: 805-559-1824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: THOMAS NIXEY
Title or Position: DIRECTOR
Credential:
Phone: 805-559-1824