MEDICARE: URSULA MOONSAMY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1053607713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URSULA MOONSAMY

Provider Business Mailing Address
First Line	:	3341 LAKESHORE AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94610-2305
Country	:	US
Telephone Number	:	510-832-3937
Fax Number	:	510-832-5166

Provider Business Practice Location Address
First Line	:	3341 LAKESHORE AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94610-2305
Country	:	US
Telephone Number	:	510-832-3937
Fax Number	:	510-832-5166

Authorized Official
Title or Position	:	OWNER
Name	:	URSULA MOONSAMY
Credential	:
Telephone Number	:	510-832-3937

Provider Enumeration Date	:	06/21/2011
Last Update Date	:	03/14/2012

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Directions to “URSULA MOONSAMY ” Practice Location

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