=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669528378
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EYEXAM OF CALIFORNIA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2007
-----------------------------------------------------
Last Update Date | 05/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7007 FRIARS RD FASHION VALLEY CENTER #720
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92108-1148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-683-5551
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7007 FRIARS RD FASHION VALLEY CENTER #720
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92108-1148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-683-5551
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICARE SUPERVISOR
-----------------------------------------------------
Name | MS. WENDY UHLS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 513-765-3534
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------