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General NPI Number Information
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NPI Number | 1841692498
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Entity Type | Organization
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Legal Business Name | ENLIGHTEN OPTOMETRY INC
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Dates
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Enumeration Date | 09/25/2014
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Last Update Date | 09/25/2014
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Provider Practice Location Address
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Address Line | 46 MAIN ST
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City | TIBURON
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State | CA
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Zip | 94920-2508
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Country | US
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Telephone | 415-488-5068
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Fax |
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Provider Business Mailing Address
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Address Line | 46 MAIN ST
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City | TIBURON
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State | CA
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Zip | 94920-2508
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CELIA FUTCH
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Credential |
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Telephone | 707-694-9581
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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 | 14494TLG
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License Number State | CA
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