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General NPI Number Information
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NPI Number | 1710566096
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Entity Type | Organization
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Legal Business Name | THE EYE DOCTOR, INC.
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Dates
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Enumeration Date | 04/05/2021
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Last Update Date | 04/05/2021
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Provider Practice Location Address
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Address Line | 4423 FIRST ST
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City | LIVERMORE
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State | CA
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Zip | 94551-4915
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Country | US
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Telephone | 925-292-0025
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Fax |
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Provider Business Mailing Address
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Address Line | 4423 FIRST ST
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City | LIVERMORE
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State | CA
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Zip | 94551-4915
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Country | US
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Telephone | 925-292-0025
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. DIANA THU NGUYEN
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Credential | OD
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Telephone | 510-427-1095
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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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