Healthcare Provider Details

I. General information

NPI: 1225256977
Provider Name (Legal Business Name): EYE MEDICAL CLINIC OF SANTA CLARA VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 12/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 MERIDIAN AVE
SAN JOSE CA
95126-2903
US

IV. Provider business mailing address

220 MERIDIAN AVE
SAN JOSE CA
95126-2903
US

V. Phone/Fax

Practice location:
  • Phone: 408-869-3401
  • Fax:
Mailing address:
  • Phone: 408-869-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number000G93010
License Number StateCA

VIII. Authorized Official

Name: BILLIE COTTRELL
Title or Position: OFFICE MANAGER
Credential:
Phone: 408-869-3400