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General NPI Number Information
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NPI Number | 1114102720
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Entity Type | Organization
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Legal Business Name | 20-20 OPTOMETRY INC
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Dates
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Enumeration Date | 01/02/2008
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Last Update Date | 02/05/2009
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Provider Practice Location Address
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Address Line | 115 W 25TH AVE
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City | SAN MATEO
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State | CA
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Zip | 94403-2259
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Country | US
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Telephone | 650-349-5733
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Fax |
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Provider Business Mailing Address
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Address Line | 115 W 25TH AVE
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City | SAN MATEO
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State | CA
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Zip | 94403-2259
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Country | US
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Telephone | 650-349-5733
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GREGORY TOM
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Credential | O.D.
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Telephone | 650-349-5733
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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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