Healthcare Provider Details

I. General information

NPI: 1619011848
Provider Name (Legal Business Name): GENEVA EYE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 GENEVA AVE
SAN FRANCISCO CA
94112-3403
US

IV. Provider business mailing address

940 GENEVA AVE
SAN FRANCISCO CA
94112-3403
US

V. Phone/Fax

Practice location:
  • Phone: 415-585-6588
  • Fax: 415-585-6403
Mailing address:
  • Phone: 415-585-6588
  • Fax: 415-585-6403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10244TPL
License Number StateCA

VIII. Authorized Official

Name: DR. LYLY UNG
Title or Position: OWNER
Credential: O.D.
Phone: 415-585-6588