Healthcare Provider Details

I. General information

NPI: 1588103204
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: 02/14/2017
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1287 INGLEWOOD AVE
SAINT HELENA CA
94574-2215
US

IV. Provider business mailing address

895 TRANCAS ST
NAPA CA
94558-3040
US

V. Phone/Fax

Practice location:
  • Phone: 707-963-5236
  • Fax: 707-963-1492
Mailing address:
  • Phone: 707-252-2020
  • Fax: 707-252-0329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JEAN MILLER
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 707-963-5236