Healthcare Provider Details

I. General information

NPI: 1649694571
Provider Name (Legal Business Name): VISUAL EYES OPTOMETRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4555 HOPYARD RD STE C-19
PLEASANTON CA
94588-2771
US

IV. Provider business mailing address

4555 HOPYARD RD STE C-19
PLEASANTON CA
94588-2771
US

V. Phone/Fax

Practice location:
  • Phone: 925-463-7330
  • Fax: 925-463-7337
Mailing address:
  • Phone: 925-463-7330
  • Fax: 925-463-7337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPT9720
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberOPT9880
License Number StateCA

VIII. Authorized Official

Name: DR. SUSAN HYUN JOO KIM- LAUBACH
Title or Position: OWNER
Credential: O.D.
Phone: 925-463-7330