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General NPI Number Information
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NPI Number | 1942858071
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Entity Type | Organization
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Legal Business Name | EYEDEOLOGY OPTOMETRY OF MISSION VIEJO
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Dates
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Enumeration Date | 09/02/2019
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Last Update Date | 09/02/2019
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Provider Practice Location Address
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Address Line | 30 THE SHOPS AT MISSION VIEJO
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6527
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Country | US
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Telephone | 949-364-4004
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Fax | 949-364-4001
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Provider Business Mailing Address
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Address Line | 145 VIA MURCIA
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-3859
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Country | US
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Telephone | 949-290-2286
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Fax | 949-364-4001
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BOBBY DARRELL SMITH II
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Credential | OD
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Telephone | 949-290-2286
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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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