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General NPI Number Information
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NPI Number | 1699814848
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Entity Type | Organization
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Legal Business Name | EAST BAY VISION CENTER OPTOMETRY INC
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 388 9TH ST STE 157
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City | OAKLAND
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State | CA
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Zip | 94607-4290
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Country | US
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Telephone | 510-268-9600
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Fax |
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Provider Business Mailing Address
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Address Line | 388 9TH ST STE 157
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City | OAKLAND
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State | CA
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Zip | 94607-4290
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Country | US
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Telephone | 510-268-9600
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. EILEEN LO
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Credential | O.D.
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Telephone | 510-268-9600
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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 | 8533T
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License Number State | CA
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