MEDICARE: EYEBRIGHT OPTOMETRY

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	14496	CA

General Provider Information

NPI Number	:	1285091702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYEBRIGHT OPTOMETRY

Provider Business Mailing Address
First Line	:	3550 CASTRO VALLEY BLVD
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-4402
Country	:	US
Telephone Number	:	510-581-1680
Fax Number	:	510-581-5070

Provider Business Practice Location Address
First Line	:	3550 CASTRO VALLEY BLVD
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-4402
Country	:	US
Telephone Number	:	510-581-1680
Fax Number	:	510-581-5070

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARY NGUYEN
Credential	:	O.D.
Telephone Number	:	510-859-7892

Provider Enumeration Date	:	01/28/2016
Last Update Date	:	01/28/2016

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Directions to “EYEBRIGHT OPTOMETRY ” Practice Location

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