Healthcare Provider Details

I. General information

NPI: 1366568545
Provider Name (Legal Business Name): MILPITAS FAMILY EYECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 E CALAVERAS BLVD
MILPITAS CA
95035-5412
US

IV. Provider business mailing address

462 E CALAVERAS BLVD
MILPITAS CA
95035-5412
US

V. Phone/Fax

Practice location:
  • Phone: 408-262-4178
  • Fax: 408-262-5351
Mailing address:
  • Phone: 408-262-4178
  • Fax: 408-262-5351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT 10094 TPA
License Number StateCA

VIII. Authorized Official

Name: DAVID SCHYMEINSKY
Title or Position: OWNER
Credential: O.D.
Phone: 408-262-4178