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General NPI Number Information
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NPI Number | 1306960588
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Entity Type | Organization
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Legal Business Name | EYESITE INC.
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1648A IRVING ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94122-1835
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Country | US
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Telephone | 415-753-1363
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Fax | 415-753-1363
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Provider Business Mailing Address
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Address Line | 1648A IRVING ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94122-1835
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Country | US
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Telephone | 415-753-1363
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Fax | 415-753-1363
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Authorized Official
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Title or Position | PRESIDENT
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Name | VIOLETA S. VILLANUEVA
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Credential | ABOC, NCLC
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Telephone | 415-753-1363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | D7004
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License Number State | CA
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