1174593784 NPI number — OPTOMETRY-VISION WITH STYLES, INC

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 1174593784 NPI number — OPTOMETRY-VISION WITH STYLES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTOMETRY-VISION WITH STYLES, INC
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:
Provider Other Organization Name Type Code:
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:
1174593784
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4892 ROYAL ISLAND WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92154-8500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-806-1194
Provider Business Mailing Address Fax Number:
619-544-2184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2260 CALLAGAN HWY
Provider Second Line Business Practice Location Address:
BUILDING 3187B STE 1
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-806-1194
Provider Business Practice Location Address Fax Number:
619-544-2184
Provider Enumeration Date:
01/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HO
Authorized Official First Name:
ANHDAO
Authorized Official Middle Name:
THI
Authorized Official Title or Position:
OPTOMETRIST/PRESIDENT
Authorized Official Telephone Number:
619-806-1194

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPT 11062T , 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)





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