1073658795 NPI number — EYE AND VISION CARE OPTOMETRIC GROUP

Table of content: (NPI 1073658795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073658795 NPI number — EYE AND VISION CARE OPTOMETRIC GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE AND VISION CARE OPTOMETRIC GROUP
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:
EYE & VISION CARE OF SANTA BARBARA
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:
1073658795
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5300 HOLLISTER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA BARBARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93111-2306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-692-6977
Provider Business Mailing Address Fax Number:
805-692-6987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5300 HOLLISTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93111-2306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-692-6977
Provider Business Practice Location Address Fax Number:
805-692-6987
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WERKHOVEN
Authorized Official First Name:
LUKE
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
805-692-6977

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  11977T , 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: CA 6765 . This is a "EYEMED TAKA NOMURA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: OP 1977T . This is a "OD LISC # LUKE WERKHOVEN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: OP 7390T . This is a "OD LISC# DAWN WOODS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 6608 . This is a "MEDICAL EYE SERVICES" identifier . This identifiers is of the category "OTHER".
  • Identifier: OP 006765 . This is a "OPTOMETRY LISC TAKA NOMUR" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: OP 11870T . This is a "OD LISC # TIFFANY CORBY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: SD 0067650 . This is a "BLUE SHEILD TAKA NOMURA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 40937 . This is a "DAVIS VISION TAKA NOMURA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6607 . This is a "MEDICAL EYE SERVICES" identifier . This identifiers is of the category "OTHER".




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