MEDICARE: JEFFREY A HOLBERT O D A PROFESSIONAL CORPORATION

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	05876T	CA

General Provider Information

NPI Number	:	1588710305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY A HOLBERT O D A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	320 W EL CAMINO REAL
Second Line	:	SUITE B-1
City	:	SUNNYVALE
State	:	CA
Zip	:	94087-1306
Country	:	US
Telephone Number	:	408-245-5725
Fax Number	:	408-356-1271

Provider Business Practice Location Address
First Line	:	320 W EL CAMINO REAL
Second Line	:	SUITE B-1
City	:	SUNNYVALE
State	:	CA
Zip	:	94087-1306
Country	:	US
Telephone Number	:	408-245-5725
Fax Number	:	408-356-1271

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEFFREY ALAN HOLBERT
Credential	:	O.D.
Telephone Number	:	408-245-5725

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	08/27/2012

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