Provider Demographics
NPI:1114063831
Name:VASQUEZ OPTICAL AND HEARING
Entity Type:Organization
Organization Name:VASQUEZ OPTICAL AND HEARING
Other - Org Name:HEARING AND LOW VISION SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO HEARING AID DISPENSER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:HEARING AID DISPENSE
Authorized Official - Phone:415-824-6865
Mailing Address - Street 1:5138 GEARY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-2816
Mailing Address - Country:US
Mailing Address - Phone:415-824-6865
Mailing Address - Fax:415-625-9766
Practice Address - Street 1:5138 GEARY BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-2816
Practice Address - Country:US
Practice Address - Phone:415-824-6865
Practice Address - Fax:415-625-9766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA1042237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ78559ZMedicaid