Healthcare Provider Details

I. General information

NPI: 1164070298
Provider Name (Legal Business Name): URBAN EYEWEAR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2019
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3345 ROSECRANS ST STE 3B
SAN DIEGO CA
92110-4225
US

IV. Provider business mailing address

2266 JUAN ST
SAN DIEGO CA
92103-1159
US

V. Phone/Fax

Practice location:
  • Phone: 805-559-1824
  • Fax:
Mailing address:
  • Phone: 805-559-1824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: THOMAS NIXEY
Title or Position: DIRECTOR
Credential:
Phone: 805-559-1824