Healthcare Provider Details

I. General information

NPI: 1528139284
Provider Name (Legal Business Name): NICHOLAS P. VROUVAS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 SUTTER ST SUITE 1500
SAN FRANCISCO CA
94108-4011
US

IV. Provider business mailing address

450 SUTTER ST SUITE 1500
SAN FRANCISCO CA
94108-4011
US

V. Phone/Fax

Practice location:
  • Phone: 415-362-2030
  • Fax: 415-362-2327
Mailing address:
  • Phone: 415-362-2030
  • Fax: 415-362-2327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5476
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: