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General NPI Number Information
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NPI Number | 1932571825
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Entity Type | Organization
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Legal Business Name | EYES ON J STREET OPTOMETRY, INC
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Dates
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Enumeration Date | 10/30/2015
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Last Update Date | 10/30/2015
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Provider Practice Location Address
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Address Line | 808 J ST
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City | SACRAMENTO
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State | CA
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Zip | 95814-2503
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Country | US
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Telephone | 916-447-3000
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Fax | 916-447-3043
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Provider Business Mailing Address
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Address Line | 808 J ST
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City | SACRAMENTO
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State | CA
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Zip | 95814-2503
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Country | US
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Telephone | 916-447-3000
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Fax | 916-447-3043
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | SARAH SWANSON
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Credential | OD
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Telephone | 916-447-3000
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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 | 11959T
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License Number State | CA
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