Healthcare Provider Details

I. General information

NPI: 1033199575
Provider Name (Legal Business Name): EDMUNDO CHARLES FIMBRES O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 01/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 HILBY AVE SUITE 1
SEASIDE CA
93955-5339
US

IV. Provider business mailing address

915 HILBY AVE STE 1
SEASIDE CA
93955-5339
US

V. Phone/Fax

Practice location:
  • Phone: 831-899-2020
  • Fax: 831-899-5504
Mailing address:
  • Phone: 831-899-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6655T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: