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General NPI Number Information
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NPI Number | 1447789623
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Entity Type | Organization
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Legal Business Name | SAN JOSE EYE CARE OPTOMETRY PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 06/09/2017
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Last Update Date | 06/09/2017
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Provider Practice Location Address
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Address Line | 301 N. JACKSON AVE #1
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City | SAN JOSE
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State | CA
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Zip | 95133
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Country | US
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Telephone | 408-259-1818
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Fax | 408-259-1871
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Provider Business Mailing Address
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Address Line | 301 N. JACKSON AVE. #1
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City | SAN JOSE
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State | CA
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Zip | 95133
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Country | US
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Telephone | 408-259-1818
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Fax | 408-259-1871
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Authorized Official
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Title or Position | PRESIDENT/OPTOMETRIST
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Name | TRACY THAO LE
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Credential | O.D
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Telephone | 408-259-1818
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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 | 11478T
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License Number State | CA
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