Healthcare Provider Details

I. General information

NPI: 1073658795
Provider Name (Legal Business Name): EYE AND VISION CARE OPTOMETRIC GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 HOLLISTER AVE
SANTA BARBARA CA
93111-2306
US

IV. Provider business mailing address

5300 HOLLISTER AVE
SANTA BARBARA CA
93111-2306
US

V. Phone/Fax

Practice location:
  • Phone: 805-692-6977
  • Fax: 805-692-6987
Mailing address:
  • Phone: 805-692-6977
  • Fax: 805-692-6987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11977T
License Number StateCA

VIII. Authorized Official

Name: DR. LUKE WERKHOVEN
Title or Position: PARTNER
Credential: O.D.
Phone: 805-692-6977