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General NPI Number Information
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NPI Number | 1679690150
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Entity Type | Organization
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Legal Business Name | PACIFIC EYE SPECIALISTS
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 50 S SAN MATEO DR STE 200
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City | SAN MATEO
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State | CA
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Zip | 94401-3859
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Country | US
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Telephone | 650-342-4595
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Fax | 650-342-3932
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Provider Business Mailing Address
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Address Line | 50 S SAN MATEO DR STE 200
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City | SAN MATEO
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State | CA
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Zip | 94401-3859
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Country | US
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Telephone | 650-342-4595
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Fax | 650-342-3932
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | LINDA QUON
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Credential | OD
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Telephone | 650-342-4595
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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 | CA
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