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General NPI Number Information
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NPI Number | 1326540113
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Entity Type | Organization
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Legal Business Name | EYE-MINDED OPTOMETRY
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Dates
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Enumeration Date | 03/07/2018
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Last Update Date | 03/07/2018
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Provider Practice Location Address
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Address Line | 7505 LAGUNA BLVD
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City | ELK GROVE
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State | CA
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Zip | 95758-5061
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Country | US
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Telephone | 916-478-7226
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Fax |
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Provider Business Mailing Address
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Address Line | 140 CHESTNUT ST
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City | VACAVILLE
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State | CA
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Zip | 95688-3805
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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 | PRESIDENT
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Name | JENNIE NGUYEN
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Credential | OD
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Telephone | 510-499-4577
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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 | 14042TLG
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License Number State | CA
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