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General NPI Number Information
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NPI Number | 1558739078
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Entity Type | Organization
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Legal Business Name | VILLA OPTOMETRY, INC.
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 04/17/2016
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Provider Practice Location Address
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Address Line | 531 TELEGRAPH CANYON RD
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City | CHULA VISTA
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State | CA
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Zip | 91910-6436
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Country | US
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Telephone | 619-482-2020
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Fax | 619-482-2671
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Provider Business Mailing Address
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Address Line | 531 TELEGRAPH CANYON RD
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City | CHULA VISTA
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State | CA
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Zip | 91910-6436
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Country | US
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Telephone | 619-482-2020
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Fax | 619-482-2671
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Authorized Official
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Title or Position | CEO
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Name | DR. ANGELICA MARIE VILLA
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Credential | O.D.
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Telephone | 858-260-9208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 10561 T
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 10561 T
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License Number State | CA
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