Healthcare Provider Details

I. General information

NPI: 1770017642
Provider Name (Legal Business Name): GOLETA VALLEY OPTOMETRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5122 HOLLISTER AVE
SANTA BARBARA CA
93111-2526
US

IV. Provider business mailing address

5122 HOLLISTER AVE
SANTA BARBARA CA
93111-2526
US

V. Phone/Fax

Practice location:
  • Phone: 805-451-8180
  • Fax: 805-456-1994
Mailing address:
  • Phone: 805-451-8180
  • Fax: 805-456-1994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number10171TLG
License Number StateCA

VIII. Authorized Official

Name: DR. CORY BREAM
Title or Position: MAJORITY OWNER
Credential: OD
Phone: 805-451-8180