Provider Demographics
NPI:1235552951
Name:DALY CITY OPTOMETRY, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DALY CITY OPTOMETRY, A PROFESSIONAL CORPORATION
Other - Org Name:DALY CITY OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MISS
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-304-3091
Mailing Address - Street 1:94B SERRAMONTE CTR
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2345
Mailing Address - Country:US
Mailing Address - Phone:650-756-4000
Mailing Address - Fax:650-756-4070
Practice Address - Street 1:94B SERRAMONTE CTR
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2345
Practice Address - Country:US
Practice Address - Phone:650-756-4000
Practice Address - Fax:650-756-4070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-31
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 12465 TPL152W00000X
CAOPT 7752 TPL152WC0802X
CAOPT 9510 TPA152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty