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General NPI Number Information
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NPI Number | 1649020702
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Entity Type | Organization
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Legal Business Name | EYESMITH, A PROFESSIONAL OPTOMETRY CORPORATION
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Dates
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Enumeration Date | 03/22/2024
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Last Update Date | 03/22/2024
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Provider Practice Location Address
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Address Line | 4029 43RD ST STE 300
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City | SAN DIEGO
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State | CA
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Zip | 92105-8537
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Country | US
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Telephone | 619-284-3937
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Fax | 619-284-3938
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Provider Business Mailing Address
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Address Line | 10956 PORTOBELO DR
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City | SAN DIEGO
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State | CA
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Zip | 92124-1181
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Country | US
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Telephone | 858-610-8488
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. THANH NGUYEN
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Credential | O.D.
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Telephone | 619-600-1161
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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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