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General NPI Number Information
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NPI Number | 1407998891
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Entity Type | Organization
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Legal Business Name | PRO OPTICS EYEWEAR CORP
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 1111 STORY RD SUITE 1079 GRAND CENTURY MALL
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City | SAN JOSE
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State | CA
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Zip | 95122
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Country | US
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Telephone | 408-288-5037
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Fax | 408-288-9265
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Provider Business Mailing Address
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Address Line | 1111 STORY RD SUITE 1079
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City | SAN JOSE
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State | CA
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Zip | 95122
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Country | US
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Telephone | 408-288-5037
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Fax | 408-288-9265
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. LINN KIM LAI
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Credential | RDO
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Telephone | 408-288-5037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | D7165
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | D7234
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License Number State | CA
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