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General NPI Number Information
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NPI Number | 1952477416
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Entity Type | Organization
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Legal Business Name | EYE SPY VISION CARE OPTOMETRY, INC
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 01/25/2013
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Provider Practice Location Address
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Address Line | 2291 SOSCOL AVE SUITE B
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City | NAPA
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State | CA
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Zip | 94558-3620
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Country | US
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Telephone | 707-253-7111
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Fax | 707-253-7192
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Provider Business Mailing Address
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Address Line | 2291 SOSCOL AVE
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City | NAPA
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State | CA
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Zip | 94558-3620
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Country | US
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Telephone | 707-253-7111
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Fax | 707-253-7192
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TANYA K MAHAPHON
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Credential | O.D.
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Telephone | 707-253-7111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | OPT 12138 TPA
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License Number State | CA
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