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General NPI Number Information
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NPI Number | 1548660673
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Entity Type | Organization
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Legal Business Name | TWO OPTOMETRY,INC.
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Dates
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Enumeration Date | 08/26/2014
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Last Update Date | 08/26/2014
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Provider Practice Location Address
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Address Line | 15888 MAIN ST STE 112A CA
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City | HESPERIA
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State | CA
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Zip | 92345-3467
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Country | US
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Telephone | 760-949-2242
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Fax |
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Provider Business Mailing Address
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Address Line | 5275 VISTA BLVD A-3
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City | SPARKS
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State | NV
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Zip | 89436-5318
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Country | US
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Telephone | 760-666-2612
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JINTAU TWO
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Credential | O.D.
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Telephone | 760-666-2612
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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 | 8606T
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License Number State | CA
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