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General NPI Number Information
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NPI Number | 1083617302
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Entity Type | Organization
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Legal Business Name | STUDIO OPTICS OPTOMETRIC GROUP, INC.
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 01/22/2008
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Provider Practice Location Address
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Address Line | 3159 MISSION COLLEGE BLVD
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City | SANTA CLARA
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State | CA
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Zip | 95054-1832
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Country | US
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Telephone | 408-492-1111
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Fax | 408-492-9255
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Provider Business Mailing Address
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Address Line | 3159 MISSION COLLEGE BLVD
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City | SANTA CLARA
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State | CA
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Zip | 95054-1832
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Country | US
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Telephone | 408-492-1111
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Fax | 408-492-9255
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MOSHE MENDELSON
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Credential | O.D.
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Telephone | 408-492-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | COR989
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License Number State | CA
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