Provider Demographics
NPI:1073658795
Name:EYE AND VISION CARE OPTOMETRIC GROUP
Entity Type:Organization
Organization Name:EYE AND VISION CARE OPTOMETRIC GROUP
Other - Org Name:EYE & VISION CARE OF SANTA BARBARA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:WERKHOVEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:805-692-6977
Mailing Address - Street 1:5300 HOLLISTER AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2306
Mailing Address - Country:US
Mailing Address - Phone:805-692-6977
Mailing Address - Fax:805-692-6987
Practice Address - Street 1:5300 HOLLISTER AVE
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2306
Practice Address - Country:US
Practice Address - Phone:805-692-6977
Practice Address - Fax:805-692-6987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11977T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA 6765OtherEYEMED TAKA NOMURA
CAOP 1977TOtherOD LISC # LUKE WERKHOVEN
CAOP 7390TOtherOD LISC# DAWN WOODS
6608OtherMEDICAL EYE SERVICES
CAOP 006765OtherOPTOMETRY LISC TAKA NOMUR
CAOP 11870TOtherOD LISC # TIFFANY CORBY
CASD 0067650OtherBLUE SHEILD TAKA NOMURA
40937OtherDAVIS VISION TAKA NOMURA
6607OtherMEDICAL EYE SERVICES
MN0667759OtherTAKA NOMURA DEA#
40937OtherDAVIS VISION TAKA NOMURA
6607OtherMEDICAL EYE SERVICES
U32549Medicare UPIN
CASD 0067650OtherBLUE SHEILD TAKA NOMURA
CAU91521Medicare UPIN
40937OtherDAVIS VISION TAKA NOMURA
CAOP 7390TOtherOD LISC# DAWN WOODS
CAOP 1977TOtherOD LISC # LUKE WERKHOVEN