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General NPI Number Information
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NPI Number | 1215296637
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Entity Type | Organization
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Legal Business Name | EYE BOUTIQUE OPTOMETRY INC
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Dates
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Enumeration Date | 05/04/2012
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Last Update Date | 02/21/2023
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Provider Practice Location Address
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Address Line | 2908 EL CAMINO REAL STE 120
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City | SANTA CLARA
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State | CA
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Zip | 95051-2944
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Country | US
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Telephone | 408-984-2020
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Fax | 408-984-2016
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Provider Business Mailing Address
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Address Line | 2908 EL CAMINO REAL STE 120
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City | SANTA CLARA
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State | CA
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Zip | 95051-2944
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Country | US
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Telephone | 408-984-2020
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Fax | 408-984-2016
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Authorized Official
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Title or Position | OWNER
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Name | SOMI OH
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Credential |
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Telephone | 408-984-2020
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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 | 7882TPA
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License Number State | CA
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