Healthcare Provider Details

I. General information

NPI: 1053513770
Provider Name (Legal Business Name): EYES OF THE AVENUE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 03/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

479 UNIVERSITY AVE
PALO ALTO CA
94301-1814
US

IV. Provider business mailing address

479 UNIVERSITY AVE
PALO ALTO CA
94301-1814
US

V. Phone/Fax

Practice location:
  • Phone: 650-327-2020
  • Fax: 650-327-2039
Mailing address:
  • Phone: 650-327-2020
  • Fax: 650-327-2039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MOHSEN HOSSEINI
Title or Position: PRESIDENT
Credential:
Phone: 408-624-1438