1669425567 NPI number — KARIN MENG MS OD AND NICOLE JANOVITCH OD PTR

Table of content: (NPI 1669425567)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669425567 NPI number — KARIN MENG MS OD AND NICOLE JANOVITCH OD PTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KARIN MENG MS OD AND NICOLE JANOVITCH OD PTR
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:
1669425567
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1210 E ARQUES AVE
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
SUNNYVALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94085-5401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-245-2020
Provider Business Mailing Address Fax Number:
408-245-2520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1210 E ARQUES AVE
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
SUNNYVALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94085-5401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-245-2020
Provider Business Practice Location Address Fax Number:
408-245-2520
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JANOVITCH
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
MONICA
Authorized Official Title or Position:
OWNER/OPTOMETRIST
Authorized Official Telephone Number:
408-245-2020

Provider Taxonomy Codes

  • Taxonomy code: 152WL0500X , with the licence number:  8546T , 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: GSD005050 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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