MEDICARE: EYE-MINDED 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	14042TLG	CA

General Provider Information

NPI Number	:	1326540113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE-MINDED OPTOMETRY

Provider Business Mailing Address
First Line	:	140 CHESTNUT ST
Second Line	:
City	:	VACAVILLE
State	:	CA
Zip	:	95688-3805
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7505 LAGUNA BLVD
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-5061
Country	:	US
Telephone Number	:	916-478-7226
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JENNIE NGUYEN
Credential	:	OD
Telephone Number	:	510-499-4577

Provider Enumeration Date	:	03/07/2018
Last Update Date	:	03/07/2018

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Directions to “EYE-MINDED OPTOMETRY ” Practice Location

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