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General NPI Number Information
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NPI Number | 1215274717
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Entity Type | Organization
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Legal Business Name | 20/20 EYE WELLNESS OPTOMETRY, INC.
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Dates
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Enumeration Date | 01/04/2013
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Last Update Date | 01/04/2013
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Provider Practice Location Address
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Address Line | 5820 STONERIDGE MALL RD SUITE 114
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City | PLEASANTON
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State | CA
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Zip | 94588-3274
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Country | US
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Telephone | 925-421-0393
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Fax |
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Provider Business Mailing Address
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Address Line | 5820 STONERIDGE MALL RD SUITE 114
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City | PLEASANTON
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State | CA
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Zip | 94588-3274
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALISHIA CHAN
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Credential |
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Telephone | 925-289-8458
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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 | 13810
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License Number State | CA
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