MEDICARE: NEOVISION EYE CENTER A MEDICAL

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	174400000X	Specialist		CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A536430	OTHER	CA	MEDICARE PTAN FOR INDIVIDUAL PRVIDER

General Provider Information

NPI Number	:	1992816383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEOVISION EYE CENTER A MEDICAL

Provider Business Mailing Address
First Line	:	2 UNION SQ FL 1
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-4495
Country	:	US
Telephone Number	:	510-431-5511
Fax Number	:	510-431-5513

Provider Business Practice Location Address
First Line	:	2 UNION SQ FL 1
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-4495
Country	:	US
Telephone Number	:	510-431-5511
Fax Number	:	510-431-5513

Authorized Official
Title or Position	:	OWNER
Name	:	SHOBHA TANDON
Credential	:	M.D.
Telephone Number	:	510-431-5511

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	05/19/2019

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Directions to “NEOVISION EYE CENTER A MEDICAL ” Practice Location

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