Healthcare Provider Details

I. General information

NPI: 1114063831
Provider Name (Legal Business Name): VASQUEZ OPTICAL AND HEARING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5138 GEARY BLVD
SAN FRANCISCO CA
94118-2816
US

IV. Provider business mailing address

5138 GEARY BLVD
SAN FRANCISCO CA
94118-2816
US

V. Phone/Fax

Practice location:
  • Phone: 415-824-6865
  • Fax: 415-625-9766
Mailing address:
  • Phone: 415-742-4440
  • Fax: 415-742-4185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA1042
License Number StateCA

VIII. Authorized Official

Name: MR. MICHAEL ANTHONY MARTINEZ
Title or Position: CEO
Credential: HEARING AID DISPENSE
Phone: 415-742-4440