=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376784413
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAY VISION EYECARE OPTOMETRY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2009
-----------------------------------------------------
Last Update Date | 04/28/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1749 BROADWAY
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94612-2105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-835-8344
-----------------------------------------------------
Fax | 510-835-8346
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1749 BROADWAY
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94612-2105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-835-8344
-----------------------------------------------------
Fax | 510-835-8346
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESDENT
-----------------------------------------------------
Name | DR. RAJLEEN K ARORA
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 510-835-8344
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1313T
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------