Healthcare Provider Details

I. General information

NPI: 1770105827
Provider Name (Legal Business Name): C V OPTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2186 GEARY BLVD STE 102
SAN FRANCISCO CA
94115-3456
US

IV. Provider business mailing address

2186 GEARY BLVD STE 102
SAN FRANCISCO CA
94115-3456
US

V. Phone/Fax

Practice location:
  • Phone: 925-550-7783
  • Fax:
Mailing address:
  • Phone: 925-550-7783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: KLARA BEZVERKH
Title or Position: PRESIDENT
Credential:
Phone: 415-921-3222