Healthcare Provider Details

I. General information

NPI: 1295892040
Provider Name (Legal Business Name): EAST HILLS VISION CARE, AN OPTOMETRIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 S WHITE RD STE A
SAN JOSE CA
95127-3821
US

IV. Provider business mailing address

1080 S WHITE RD STE A
SAN JOSE CA
95127-3821
US

V. Phone/Fax

Practice location:
  • Phone: 408-272-3002
  • Fax: 408-272-0820
Mailing address:
  • Phone: 408-272-3002
  • Fax: 408-272-0820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberCOR 646
License Number StateCA

VIII. Authorized Official

Name: BARBARA L JUNG
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 408-272-3002