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General NPI Number Information
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NPI Number | 1306512678
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Entity Type | Organization
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Legal Business Name | PACIFIC VISION MANAGEMENT LLC
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Dates
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Enumeration Date | 08/18/2021
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Last Update Date | 09/24/2021
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Provider Practice Location Address
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Address Line | 1 DANIEL BURNHAM CT STE 170C
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City | SAN FRANSICO
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State | CA
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Zip | 94133
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Country | US
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Telephone | 415-922-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 1 DANIEL BURNHAM CT STE 110
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City | SAN FRANSICO
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State | CA
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Zip | 94133
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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 | ADMINISTRATOR
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Name | GENE FAKTOROVICH
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Credential |
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Telephone | 415-922-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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