MEDICARE: EYE MEDICAL CLINIC OF SANTA CLARA VALLEY

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	332H00000X	Eyewear Supplier	000G93010	CA

General Provider Information

NPI Number	:	1225256977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE MEDICAL CLINIC OF SANTA CLARA VALLEY

Provider Business Mailing Address
First Line	:	220 MERIDIAN AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-2903
Country	:	US
Telephone Number	:	408-869-3400
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 MERIDIAN AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-2903
Country	:	US
Telephone Number	:	408-869-3401
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	BILLIE COTTRELL
Credential	:
Telephone Number	:	408-869-3400

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	12/02/2009

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