Provider Demographics
NPI:1194816629
Name:PENZA, VINCENT PAUL (OD OPTOMETRIST)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:PAUL
Last Name:PENZA
Suffix:
Gender:M
Credentials:OD OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:530 BUSH ST
Mailing Address - Street 2:STE 101
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-3610
Mailing Address - Country:US
Mailing Address - Phone:415-291-8560
Mailing Address - Fax:415-291-8573
Practice Address - Street 1:530 BUSH ST
Practice Address - Street 2:STE 101
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-3610
Practice Address - Country:US
Practice Address - Phone:415-291-8560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2020-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT8305TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2278849OtherFIRST HEALTH CCN
CA4404683OtherAETNA
CASD0083050OtherBLUE SHIELD OF CA