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General NPI Number Information
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NPI Number | 1881825081
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Entity Type | Organization
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Legal Business Name | GENE SERPA'S LUXTON OPTICAL CO,INC
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Dates
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Enumeration Date | 08/05/2009
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Last Update Date | 08/05/2009
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Provider Practice Location Address
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Address Line | 212 BON AIR CTR
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City | GREENBRAE
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State | CA
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Zip | 94904-2416
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Country | US
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Telephone | 415-461-9222
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Fax | 415-461-3958
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Provider Business Mailing Address
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Address Line | 212 BON AIR CTR
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City | GREENBRAE
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State | CA
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Zip | 94904-2416
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Country | US
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Telephone | 415-461-9222
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Fax | 415-461-3958
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. PATRICIA ANN SERPA
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Credential |
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Telephone | 415-461-9222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 1956
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License Number State | CA
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