Healthcare Provider Details

I. General information

NPI: 1275641706
Provider Name (Legal Business Name): ALTOS OPTICAL CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

762 ALTOS OAKS DR SUITE 3
LOS ALTOS CA
94024-5434
US

IV. Provider business mailing address

762 ALTOS OAKS DR SUITE 3
LOS ALTOS CA
94024-5434
US

V. Phone/Fax

Practice location:
  • Phone: 650-948-0403
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number141855
License Number StateCA

VIII. Authorized Official

Name: JUDY DALEY
Title or Position: OPTICIAN
Credential: ABOC
Phone: 650-948-0403