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General NPI Number Information
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NPI Number | 1306179635
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Entity Type | Organization
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Legal Business Name | PALO ALTO EYEWORKS
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Dates
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Enumeration Date | 09/18/2009
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Last Update Date | 09/18/2009
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Provider Practice Location Address
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Address Line | 461 S CALIFORNIA AVE
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City | PALO ALTO
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State | CA
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Zip | 94306-1832
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Country | US
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Telephone | 650-327-5665
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Fax | 650-327-5650
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Provider Business Mailing Address
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Address Line | 461 S CALIFORNIA AVE
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City | PALO ALTO
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State | CA
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Zip | 94306-1832
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Country | US
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Telephone | 650-327-5665
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Fax | 650-327-5650
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Authorized Official
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Title or Position | OWNER
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Name | MR. ROBERT C MARTINEZ
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Credential | OPTICIAN
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Telephone | 650-327-5665
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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 | SR GH 99167351
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License Number State | CA
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