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General NPI Number Information
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NPI Number | 1982871174
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Entity Type | Organization
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Legal Business Name | MENDOZA OPTOMETRIC CORPORATION
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 01/07/2013
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Provider Practice Location Address
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Address Line | 2411 E PLAZA BLVD
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City | NATIONAL CITY
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State | CA
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Zip | 91950-5101
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Country | US
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Telephone | 619-475-2184
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Fax |
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Provider Business Mailing Address
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Address Line | 2411 E PLAZA BLVD
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City | NATIONAL CITY
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State | CA
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Zip | 91950-5101
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Country | US
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Telephone | 619-475-2184
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RAYMUNDO G MENDOZA
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Credential | OD
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Telephone | 619-475-2184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number | OPT 8150T
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License Number State |
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