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General NPI Number Information
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NPI Number | 1164497905
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Entity Type | Organization
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Legal Business Name | HERITAGE VALLEY EYE CARE OPTOMETRIC CENTER
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 400 E SANTA BARBARA ST STE C
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City | SANTA PAULA
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State | CA
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Zip | 93060-2675
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Country | US
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Telephone | 805-525-6603
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Fax | 805-525-6115
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Provider Business Mailing Address
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Address Line | 400 E SANTA BARBARA ST STE C
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City | SANTA PAULA
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State | CA
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Zip | 93060-2675
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Country | US
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Telephone | 805-525-6603
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Fax | 805-525-6115
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Authorized Official
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Title or Position | TREASURER
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Name | DR. AARON M LUEKENGA
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Credential | OD
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Telephone | 805-525-6603
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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 | COR618
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License Number State | CA
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