Healthcare Provider Details

I. General information

NPI: 1306960588
Provider Name (Legal Business Name): EYESITE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1648A IRVING ST
SAN FRANCISCO CA
94122-1835
US

IV. Provider business mailing address

1648A IRVING ST
SAN FRANCISCO CA
94122-1835
US

V. Phone/Fax

Practice location:
  • Phone: 415-753-1363
  • Fax: 415-753-1363
Mailing address:
  • Phone: 415-753-1363
  • Fax: 415-753-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberD7004
License Number StateCA

VIII. Authorized Official

Name: VIOLETA S. VILLANUEVA
Title or Position: PRESIDENT
Credential: ABOC, NCLC
Phone: 415-753-1363