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General NPI Number Information
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NPI Number | 1700941853
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Entity Type | Organization
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Legal Business Name | PENZA & MORIOKA OPTOMETRY INC
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 03/30/2020
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Provider Practice Location Address
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Address Line | 530 BUSH ST SUITE 101
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City | SAN FRANCISCO
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State | CA
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Zip | 94108
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Country | US
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Telephone | 415-291-8560
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Fax | 415-291-8573
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Provider Business Mailing Address
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Address Line | 530 BUSH ST SUITE 101
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City | SAN FRANCISCO
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State | CA
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Zip | 94108
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Country | US
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Telephone | 415-291-8560
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Fax | 415-291-8573
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Authorized Official
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Title or Position | AUTHORIZED AND DELEGATED OFFICIAL
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Name | DR. VINCENT PENZA
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Credential | OD
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Telephone | 415-291-8560
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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 | 11219TCA
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT8287TPA
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT8305TPA
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License Number State | CA
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