Healthcare Provider Details

I. General information

NPI: 1275698896
Provider Name (Legal Business Name): ROMUALDO D. ENRIQUEZ OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ROMUALDO D. ENRIQUEZ OPTICIAN

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5805 MISSION ST
SAN FRANCISCO CA
94112-4017
US

IV. Provider business mailing address

5805 MISSION ST
SAN FRANCISCO CA
94112-4017
US

V. Phone/Fax

Practice location:
  • Phone: 415-469-8210
  • Fax: 415-469-0283
Mailing address:
  • Phone: 415-469-8210
  • Fax: 415-469-0283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License NumberA7377
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number20633
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: