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General NPI Number Information
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NPI Number | 1003347493
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Entity Type | Organization
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Legal Business Name | MI EYES OPTOMETRY
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Dates
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Enumeration Date | 03/27/2017
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Last Update Date | 03/27/2017
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Provider Practice Location Address
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Address Line | 5625 GOSFORD RD
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City | BAKERSFIELD
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State | CA
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Zip | 93313-4999
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Country | US
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Telephone | 661-665-8327
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Fax |
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Provider Business Mailing Address
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Address Line | 5625 GOSFORD RD
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City | BAKERSFIELD
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State | CA
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Zip | 93313-4999
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Country | US
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Telephone | 661-665-8327
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK CHEUNG
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Credential | O.D.
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Telephone | 661-665-8327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 14371
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License Number State | CA
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