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General NPI Number Information
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NPI Number | 1760657522
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Entity Type | Organization
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Legal Business Name | GENDELMAN OPTOMETRY, INC @ THE VISION STORE
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 884 EASTLAKE PKWY SUITE 1617
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City | CHULA VISTA
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State | CA
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Zip | 91914-4547
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Country | US
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Telephone | 619-651-9602
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Fax | 619-651-9604
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Provider Business Mailing Address
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Address Line | 884 EASTLAKE PKWY SUITE 1617
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City | CHULA VISTA
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State | CA
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Zip | 91914-4547
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Country | US
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Telephone | 619-651-9602
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Fax | 619-651-9604
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IRENE J. GENDELMAN
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Credential | O.D.
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Telephone | 619-651-9602
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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 | 13305
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License Number State | CA
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