Healthcare Provider Details

I. General information

NPI: 1255887006
Provider Name (Legal Business Name): EYE CANDY, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4423 FIRST STREET
LIVERMORE CA
94551
US

IV. Provider business mailing address

4423 FIRST STREET
LIVERMORE CA
94551
US

V. Phone/Fax

Practice location:
  • Phone: 510-421-7957
  • Fax:
Mailing address:
  • Phone: 510-421-7957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number201612610461
License Number StateCA

VIII. Authorized Official

Name: ANDY NGUYEN
Title or Position: MANAGER
Credential:
Phone: 510-421-7957