Healthcare Provider Details

I. General information

NPI: 1346825734
Provider Name (Legal Business Name): HEAL MY EYES OPTOMETRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1844 SAN MIGUEL DR STE 300C
WALNUT CREEK CA
94596-4962
US

IV. Provider business mailing address

1844 SAN MIGUEL DR STE 300C
WALNUT CREEK CA
94596-4962
US

V. Phone/Fax

Practice location:
  • Phone: 510-693-8053
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State

VIII. Authorized Official

Name: NGUYEN TRAN
Title or Position: OPTOMETRIST
Credential:
Phone: 916-719-0615