Provider Demographics
NPI:1215375753
Name:AVERY, OBOESI VANESSA (OD)
Entity Type:Individual
Prefix:
First Name:OBOESI
Middle Name:VANESSA
Last Name:AVERY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:OBOESI
Other - Middle Name:VANESSA
Other - Last Name:BRAIMAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4 EMBARCADERO CTR
Mailing Address - Street 2:LOBBY LEVEL
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-4106
Mailing Address - Country:US
Mailing Address - Phone:415-772-8282
Mailing Address - Fax:415-772-8222
Practice Address - Street 1:4 EMBARCADERO CTR
Practice Address - Street 2:LOBBY LEVEL
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-4106
Practice Address - Country:US
Practice Address - Phone:415-772-8282
Practice Address - Fax:415-772-8222
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010652152WL0500X
CA14882152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation