Healthcare Provider Details

I. General information

NPI: 1134573678
Provider Name (Legal Business Name): GORDON SCHANZLIN NEW VISION INSTITUTE, INC. A PROFESSIONAL MEDICAL COR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8910 UNIVERSITY CENTER LN SUITE 800
SAN DIEGO CA
92122-1029
US

IV. Provider business mailing address

8910 UNIVERSITY CENTER LN SUITE 800
SAN DIEGO CA
92122-1029
US

V. Phone/Fax

Practice location:
  • Phone: 858-455-6800
  • Fax: 858-455-0244
Mailing address:
  • Phone: 858-455-6800
  • Fax: 858-455-0244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. CATHI LYONS
Title or Position: ADMINISTRATOR
Credential:
Phone: 858-455-6800