MEDICARE: YOUR TWO EYES OPTOMETRY INC.

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	:	1184287641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR TWO EYES OPTOMETRY INC.

Provider Business Mailing Address
First Line	:	2110 VINE ST STE B
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94709-1577
Country	:	US
Telephone Number	:	510-540-5555
Fax Number	:	510-548-3999

Provider Business Practice Location Address
First Line	:	2110 VINE ST STE B
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94709-1577
Country	:	US
Telephone Number	:	510-540-5555
Fax Number	:	510-548-3999

Authorized Official
Title or Position	:	OWNER
Name	:	NADIA SAMII
Credential	:	OD
Telephone Number	:	510-926-2102

Provider Enumeration Date	:	04/19/2019
Last Update Date	:	04/19/2019

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