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General NPI Number Information
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NPI Number | 1770017642
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Entity Type | Organization
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Legal Business Name | GOLETA VALLEY OPTOMETRY INC
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Dates
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Enumeration Date | 04/17/2017
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Last Update Date | 05/14/2019
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Provider Practice Location Address
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Address Line | 5122 HOLLISTER AVE
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City | SANTA BARBARA
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State | CA
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Zip | 93111-2526
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Country | US
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Telephone | 805-451-8180
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Fax | 805-456-1994
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Provider Business Mailing Address
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Address Line | 5122 HOLLISTER AVE
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City | SANTA BARBARA
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State | CA
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Zip | 93111-2526
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Country | US
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Telephone | 805-451-8180
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Fax | 805-456-1994
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Authorized Official
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Title or Position | MAJORITY OWNER
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Name | DR. CORY BREAM
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Credential | OD
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Telephone | 805-451-8180
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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 | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 10171TLG
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License Number State | CA
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