Healthcare Provider Details

I. General information

NPI: 1225459795
Provider Name (Legal Business Name): STEVEN A. NEUNZIG, O.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2013
Last Update Date: 12/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 SCOTT BLVD
SANTA CLARA CA
95050-4562
US

IV. Provider business mailing address

1190 SCOTT BLVD
SANTA CLARA CA
95050-4562
US

V. Phone/Fax

Practice location:
  • Phone: 408-241-3510
  • Fax: 408-247-2605
Mailing address:
  • Phone: 408-241-3510
  • Fax: 408-247-2605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11535
License Number StateCA

VIII. Authorized Official

Name: DR. STEVEN NEUNZIG
Title or Position: PRESIDENT
Credential: O.D.
Phone: 408-241-3510