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General NPI Number Information
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NPI Number | 1457643132
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Entity Type | Organization
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Legal Business Name | OHANA EYECARE INC.
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Dates
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Enumeration Date | 05/12/2011
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Last Update Date | 02/22/2016
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Provider Practice Location Address
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Address Line | 1420 TRAVIS BLVD
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City | FAIRFIELD
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State | CA
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Zip | 94533-3401
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Country | US
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Telephone | 707-425-6333
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Fax | 707-428-1685
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Provider Business Mailing Address
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Address Line | 135 CALVERT CT
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City | PIEDMONT
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State | CA
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Zip | 94611-3437
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Country | US
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Telephone | 510-610-1479
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KELLY LEE
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Credential | O.D.
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Telephone | 510-610-1479
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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 | 13690
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License Number State | CA
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