Provider Demographics
NPI:1194844837
Name:SITE FOR SORE EYES
Entity Type:Organization
Organization Name:SITE FOR SORE EYES
Other - Org Name:PACIFIC OPTICAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:SALMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-477-4900
Mailing Address - Street 1:3555 CLARES ST
Mailing Address - Street 2:STE H
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2555
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3555 CLARES ST
Practice Address - Street 2:STE H
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2555
Practice Address - Country:US
Practice Address - Phone:831-477-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD7055156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty