MEDICARE: DE ANZA VISION CENTER A PROFESSIONAL OPTOMETRIC CORP

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	7759T	CA

General Provider Information

NPI Number	:	1760507784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DE ANZA VISION CENTER A PROFESSIONAL OPTOMETRIC CORP

Provider Business Mailing Address
First Line	:	1035 S DE ANZA BLVD
Second Line	:	SUITE ONE
City	:	SAN JOSE
State	:	CA
Zip	:	95129-2772
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1035 S DE ANZA BLVD
Second Line	:	SUITE ONE
City	:	SAN JOSE
State	:	CA
Zip	:	95129-2772
Country	:	US
Telephone Number	:	408-446-5533
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEPHANIE JOO
Credential	:	O.D.
Telephone Number	:	408-446-5533

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	01/27/2025

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