Healthcare Provider Details

I. General information

NPI: 1790781409
Provider Name (Legal Business Name): EYE CARE CENTER OF NAPA VALLEY A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 TRANCAS ST
NAPA CA
94558-3040
US

IV. Provider business mailing address

895 TRANCAS ST
NAPA CA
94558-3040
US

V. Phone/Fax

Practice location:
  • Phone: 707-252-2020
  • Fax: 707-252-0329
Mailing address:
  • Phone: 707-252-2020
  • Fax: 707-252-0329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: KENA BURKE
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 707-252-2020