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General NPI Number Information
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NPI Number | 1770814196
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Entity Type | Organization
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Legal Business Name | JORGE A. CUADROS OPTOMETRIC CORP.
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Dates
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Enumeration Date | 01/25/2010
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Last Update Date | 01/25/2010
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Provider Practice Location Address
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Address Line | 678 E SANTA CLARA ST
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City | SAN JOSE
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State | CA
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Zip | 95112-1931
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Country | US
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Telephone | 408-293-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 678 E SANTA CLARA ST
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City | SAN JOSE
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State | CA
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Zip | 95112-1931
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Country | US
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Telephone | 408-293-2020
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST OWNER PARTNER
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Name | DR. CHARLES T HOLT
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Credential | O.,D.
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Telephone | 408-293-2020
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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 | 10221T
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License Number State | CA
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