Healthcare Provider Details

I. General information

NPI: 1013074160
Provider Name (Legal Business Name): ROBERT E PAQUETTE OPTICIAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/01/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 CASTRO ST STE C
MOUNTAIN VIEW CA
94041-2013
US

IV. Provider business mailing address

785 CASTRO ST STE C
MOUNTAIN VIEW CA
94041-2013
US

V. Phone/Fax

Practice location:
  • Phone: 650-965-4488
  • Fax:
Mailing address:
  • Phone: 650-965-4488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License NumberD1917
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberD1917
License Number StateCA

VIII. Authorized Official

Name: BONNIE ALYCE BONEY
Title or Position: CEO OPTICIAN
Credential:
Phone: 650-965-4488