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General NPI Number Information
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NPI Number | 1053513770
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Entity Type | Organization
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Legal Business Name | EYES OF THE AVENUE, INC.
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 03/26/2010
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Provider Practice Location Address
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Address Line | 479 UNIVERSITY AVE
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City | PALO ALTO
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State | CA
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Zip | 94301-1814
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Country | US
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Telephone | 650-327-2020
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Fax | 650-327-2039
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Provider Business Mailing Address
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Address Line | 479 UNIVERSITY AVE
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City | PALO ALTO
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State | CA
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Zip | 94301-1814
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Country | US
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Telephone | 650-327-2020
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Fax | 650-327-2039
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Authorized Official
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Title or Position | PRESIDENT
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Name | MOHSEN HOSSEINI
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Credential |
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Telephone | 408-624-1438
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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 |
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License Number State |
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