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General NPI Number Information
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NPI Number | 1518136043
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Entity Type | Organization
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Legal Business Name | EVERGREEN EYECARE OPTOMETRY INC.
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Dates
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Enumeration Date | 02/28/2008
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Last Update Date | 05/22/2009
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Provider Practice Location Address
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Address Line | 3005 SILVER CREEK RD STE 104
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City | SAN JOSE
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State | CA
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Zip | 95121-1789
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Country | US
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Telephone | 408-238-4900
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Fax | 408-238-4903
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Provider Business Mailing Address
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Address Line | 3005 SILVER CREEK RD STE 104
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City | SAN JOSE
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State | CA
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Zip | 95121-1789
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Country | US
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Telephone | 408-238-4900
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Fax | 408-238-4903
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Authorized Official
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Title or Position | PRESIDENT
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Name | BANG K. TRAN
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Credential | O.D.
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Telephone | 408-238-4900
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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 | 12009T
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License Number State | CA
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