Healthcare Provider Details

I. General information

NPI: 1285840488
Provider Name (Legal Business Name): ST MARY'S EYE SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 12/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 HAYES ST SUITE 208
SAN FRANCISCO CA
94117-1078
US

IV. Provider business mailing address

2250 HAYES ST SUITE 208
SAN FRANCISCO CA
94117-1078
US

V. Phone/Fax

Practice location:
  • Phone: 415-387-8887
  • Fax: 415-387-3383
Mailing address:
  • Phone: 415-387-8887
  • Fax: 415-387-3383

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 NumberG53132
License Number StateCA

VIII. Authorized Official

Name: MARILYN MAESTAS
Title or Position: MANAGER
Credential:
Phone: 415-387-8887