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General NPI Number Information
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NPI Number | 1447215975
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Entity Type | Organization
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Legal Business Name | ENVISION EYE, A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 02/15/2008
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Provider Practice Location Address
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Address Line | 9834 GENESEE AVE SUITE 406
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City | LA JOLLA
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State | CA
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Zip | 92037-1223
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Country | US
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Telephone | 858-450-1010
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Fax | 858-450-9451
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Provider Business Mailing Address
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Address Line | 9834 GENESEE AVE SUITE 406
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City | LA JOLLA
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State | CA
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Zip | 92037-1223
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Country | US
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Telephone | 858-450-1010
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Fax | 858-450-9451
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PADMA NANDURI
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Credential | M.D., F.A.C.S.
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Telephone | 858-450-1010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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