1497049043 NPI number — TRIBAL EYES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497049043 NPI number — TRIBAL EYES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRIBAL EYES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TRIBAL EYES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497049043
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6207 MAJESTIC AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94605-1860
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-361-8879
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 FRANKLIN STREET
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94607-3759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-268-8091
Provider Business Practice Location Address Fax Number:
510-268-8093
Provider Enumeration Date:
05/31/2011

Additional Information

Authorized Official

Authorized Official Last Name:
COLEMAN
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
STEPHEN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
510-361-8879

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , with the licence number:  D7655 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 28010222 . This is a "CITY OF OAKLAND BUSINESS LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: C3388261 . This is a "SECRETARY OF STATE CORPORATION FILE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: D7655 . This is a "MEDICAL BOARD, REGISTERED DISPENSING OPTICIAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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