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General NPI Number Information
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NPI Number | 1760670624
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Entity Type | Organization
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Legal Business Name | BALFOUR VISION OPTIX OPTOMETRY INC.
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 08/04/2019
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Provider Practice Location Address
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Address Line | 5113 LONE TREE WAY
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City | ANTIOCH
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State | CA
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Zip | 94531-8484
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Country | US
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Telephone | 925-778-1505
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Fax |
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Provider Business Mailing Address
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Address Line | 3840 BALFOUR RD STE A
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City | BRENTWOOD
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State | CA
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Zip | 94513-1641
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Country | US
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Telephone | 925-513-0323
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WINSON ONG
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Credential | O.D.
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Telephone | 925-513-0323
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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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