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General NPI Number Information
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NPI Number | 1902125180
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Entity Type | Organization
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Legal Business Name | MODERN EYES OPTOMETRY, INC.
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Dates
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Enumeration Date | 05/27/2010
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Last Update Date | 03/30/2017
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Provider Practice Location Address
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Address Line | 63 W ANGELA ST
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City | PLEASANTON
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State | CA
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Zip | 94566-7328
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Country | US
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Telephone | 925-456-4393
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Fax |
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Provider Business Mailing Address
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Address Line | 63 W ANGELA ST
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City | PLEASANTON
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State | CA
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Zip | 94566-7328
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Country | US
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Telephone | 925-456-4393
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JACK SON KIM
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Credential | O.D.
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Telephone | 562-809-2020
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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 |
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License Number State |
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