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General NPI Number Information
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NPI Number | 1427366145
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Entity Type | Organization
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Legal Business Name | SAN CLEMENTE OPTOMETRY CORP
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Dates
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Enumeration Date | 09/15/2010
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Last Update Date | 04/18/2011
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Provider Practice Location Address
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Address Line | 224 AVENIDA DEL MAR SUITE A
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-4011
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Country | US
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Telephone | 949-492-2029
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Fax | 949-492-0049
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Provider Business Mailing Address
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Address Line | 224 AVENIDA DEL MAR SUITE A
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-4011
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Country | US
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Telephone | 949-492-2029
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Fax | 949-492-0049
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID J NOTA
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Credential | O.D.
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Telephone | 949-492-2029
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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 | 10391T
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License Number State | CA
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