Healthcare Provider Details

I. General information

NPI: 1770248155
Provider Name (Legal Business Name): VAN HOOSE OPTOMETRIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 11/01/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7246 CLAIREMONT MESA BLVD
SAN DIEGO CA
92111-1007
US

IV. Provider business mailing address

PO BOX 175
RANCHO SANTA FE CA
92067-0175
US

V. Phone/Fax

Practice location:
  • Phone: 858-292-7193
  • Fax: 858-292-8247
Mailing address:
  • Phone: 760-560-7501
  • Fax: 858-292-8247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State

VIII. Authorized Official

Name: MARC VAN HOOSE
Title or Position: PRESIDENT
Credential: O.D.
Phone: 760-560-7501