1790954824 NPI number — AMANDA MICHELLE PARREIRA

Table of content: (NPI 1790954824)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790954824 NPI number — AMANDA MICHELLE PARREIRA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMANDA MICHELLE PARREIRA
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:
SAN LUIS OBISPO OPTOMETRIC CENTER
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:
1790954824
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
894 MEINECKE AVE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
SAN LUIS OBISPO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93405-1722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-543-6632
Provider Business Mailing Address Fax Number:
805-543-6863

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
894 MEINECKE AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SAN LUIS OBISPO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93405-1722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-543-6632
Provider Business Practice Location Address Fax Number:
805-543-6863
Provider Enumeration Date:
02/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PARREIRA
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
OWNER/OPTOMETRIST
Authorized Official Telephone Number:
805-543-6632

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  11202T , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332H00000X , with the licence number: 11202T , 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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