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General NPI Number Information
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NPI Number | 1285874685
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Entity Type | Organization
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Legal Business Name | LIVE OPTICS, FAMILY BOUTIQUE
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Dates
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Enumeration Date | 02/24/2009
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Last Update Date | 02/24/2009
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Provider Practice Location Address
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Address Line | 39159 PASEO PADRE PKWY STE 117
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City | FREMONT
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State | CA
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Zip | 94538-1600
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Country | US
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Telephone | 510-494-8880
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Fax | 510-494-8882
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Provider Business Mailing Address
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Address Line | 39159 PASEO PADRE PKWY STE 117
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City | FREMONT
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State | CA
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Zip | 94538-1600
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Country | US
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Telephone | 510-494-8880
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Fax | 510-494-8882
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Authorized Official
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Title or Position | CEO/ OPTICIAN
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Name | EDITH C LIVELO
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Credential | RDO
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Telephone | 510-494-8880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | D 6765
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License Number State | CA
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