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General NPI Number Information
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NPI Number | 1780571877
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Entity Type | Organization
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Legal Business Name | PENINSULA EYE MEDICAL GROUP
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Dates
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Enumeration Date | 06/20/2025
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 1391 WOODSIDE RD STE 200
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City | REDWOOD CITY
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State | CA
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Zip | 94061-3574
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Country | US
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Telephone | 650-324-0056
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Fax |
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Provider Business Mailing Address
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Address Line | 1391 WOODSIDE RD STE 200
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City | REDWOOD CITY
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State | CA
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Zip | 94061-3574
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Country | US
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Telephone | 650-324-0056
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JUDITH NEVITT
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Credential | MD
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Telephone | 650-324-0056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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