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General NPI Number Information
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NPI Number | 1619158755
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Entity Type | Organization
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Legal Business Name | NORTH COAST VISION
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Dates
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Enumeration Date | 11/16/2007
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Last Update Date | 11/16/2007
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Provider Practice Location Address
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Address Line | 804 41ST AVE
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City | SANTA CRUZ
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State | CA
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Zip | 95062-4421
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Country | US
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Telephone | 831-462-5945
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Fax | 831-462-5937
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Provider Business Mailing Address
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Address Line | 804 41ST AVE
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City | SANTA CRUZ
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State | CA
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Zip | 95062-4421
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Country | US
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Telephone | 831-462-5945
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Fax | 831-462-5937
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | AGNES YANG-EUN PYONG KIM
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Credential | O.D.
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Telephone | 510-965-2224
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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 |
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License Number State |
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