Healthcare Provider Details

I. General information

NPI: 1215375753
Provider Name (Legal Business Name): OBOESI VANESSA AVERY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OBOESI VANESSA BRAIMAH OD

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 EMBARCADERO CTR LOBBY LEVEL
SAN FRANCISCO CA
94111-4106
US

IV. Provider business mailing address

4 EMBARCADERO CTR LOBBY LEVEL
SAN FRANCISCO CA
94111-4106
US

V. Phone/Fax

Practice location:
  • Phone: 415-772-8282
  • Fax: 415-772-8222
Mailing address:
  • Phone: 415-772-8282
  • Fax: 415-772-8222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number046010652
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number14882
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: