=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386034452
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOR YOUR EYES ONLY OPHTHALMIC MEDICAL CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2015
-----------------------------------------------------
Last Update Date | 07/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1811 YGNACIO VALLEY RD
-----------------------------------------------------
City | WALNUT CREEK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94598-3214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-933-1344
-----------------------------------------------------
Fax | 925-946-9701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1811 YGNACIO VALLEY RD
-----------------------------------------------------
City | WALNUT CREEK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94598-3214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-933-1344
-----------------------------------------------------
Fax | 925-946-9701
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | ROSALIA SAAVEDRA
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 510-483-4770
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | BOL 6807
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------