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General NPI Number Information
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NPI Number | 1740279207
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Entity Type | Organization
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Legal Business Name | SYLVAN EYE ASSOCIATES, A MEDICAL CORPORATION
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 01/25/2011
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Provider Practice Location Address
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Address Line | 1011 SYLVAN AVE SUITE A
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City | MODESTO
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State | CA
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Zip | 95350-1692
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Country | US
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Telephone | 209-575-2020
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Fax | 209-758-5693
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Provider Business Mailing Address
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Address Line | 1011 SYLVAN AVE SUITE A
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City | MODESTO
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State | CA
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Zip | 95350-1692
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Country | US
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Telephone | 209-575-2020
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Fax | 209-758-5693
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | KERRY ALAN HORNER
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Credential | OD
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Telephone | 209-575-2020
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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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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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