Healthcare Provider Details

I. General information

NPI: 1164497905
Provider Name (Legal Business Name): HERITAGE VALLEY EYE CARE OPTOMETRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E SANTA BARBARA ST STE C
SANTA PAULA CA
93060-2675
US

IV. Provider business mailing address

400 E SANTA BARBARA ST STE C
SANTA PAULA CA
93060-2675
US

V. Phone/Fax

Practice location:
  • Phone: 805-525-6603
  • Fax: 805-525-6115
Mailing address:
  • Phone: 805-525-6603
  • Fax: 805-525-6115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberCOR618
License Number StateCA

VIII. Authorized Official

Name: DR. AARON M LUEKENGA
Title or Position: TREASURER
Credential: OD
Phone: 805-525-6603