Healthcare Provider Details

I. General information

NPI: 1427103266
Provider Name (Legal Business Name): EYEEXAM OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 LUXOTTICA PL
MASON OH
45040-8114
US

IV. Provider business mailing address

4000 LUXOTTICA PL
MASON OH
45040-8114
US

V. Phone/Fax

Practice location:
  • Phone: 513-765-6000
  • Fax:
Mailing address:
  • Phone: 513-765-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: LIZ DIGIANDOMENICO
Title or Position: SVP GENERAL MANAGER
Credential:
Phone: 513-765-6015