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General NPI Number Information
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NPI Number | 1720793169
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Entity Type | Organization
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Legal Business Name | EYES FOR KIDS AND TEENS
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Dates
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Enumeration Date | 01/19/2023
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 7373 CLAIREMONT MESA BLVD STE 104B
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City | SAN DIEGO
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State | CA
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Zip | 92111-1120
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Country | US
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Telephone | 858-495-1488
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Fax | 858-495-1489
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Provider Business Mailing Address
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Address Line | 7373 CLAIREMONT MESA BLVD STE 104B
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City | SAN DIEGO
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State | CA
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Zip | 92111-1120
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Country | US
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Telephone | 858-495-1488
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Fax | 858-495-1489
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Authorized Official
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Title or Position | OWNER
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Name | AIMEE RUTH REASONER
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Credential | RDO
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Telephone | 858-495-1488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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