Provider Demographics
NPI:1083617302
Name:STUDIO OPTICS OPTOMETRIC GROUP, INC.
Entity Type:Organization
Organization Name:STUDIO OPTICS OPTOMETRIC GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDELSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:408-492-1111
Mailing Address - Street 1:3159 MISSION COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-1832
Mailing Address - Country:US
Mailing Address - Phone:408-492-1111
Mailing Address - Fax:408-492-9255
Practice Address - Street 1:3159 MISSION COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-1832
Practice Address - Country:US
Practice Address - Phone:408-492-1111
Practice Address - Fax:408-492-9255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACOR989207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5081750001OtherMEDICARE - DMERC
CAZZZ28142ZMedicare ID - Type UnspecifiedGROUP MEDICARE NUMBER