Healthcare Provider Details

I. General information

NPI: 1508997230
Provider Name (Legal Business Name): GREAT GLASSES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3145 STEVENS CREEK BLVD
SAN JOSE CA
95117-1141
US

IV. Provider business mailing address

3145 STEVENS CREEK BLVD
SAN JOSE CA
95117-1141
US

V. Phone/Fax

Practice location:
  • Phone: 408-985-2999
  • Fax:
Mailing address:
  • Phone: 408-985-2999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberD3781
License Number StateCA

VIII. Authorized Official

Name: MR. MICHAEL FRANKLIN
Title or Position: PRESIDENT
Credential:
Phone: 408-985-2999