Provider Demographics
NPI:1083760482
Name:POON, EILEEN WUN (OD)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:WUN
Last Name:POON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:EILEEN
Other - Middle Name:WUN
Other - Last Name:POON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:7520 ARROYO CIR
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-7303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7520 ARROYO CIR
Practice Address - Street 2:STATION 2
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-7303
Practice Address - Country:US
Practice Address - Phone:408-848-7040
Practice Address - Fax:408-848-7072
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10525T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0105250Medicare ID - Type Unspecified