Provider Demographics
NPI:1265823900
Name:SITE GROUP, LLC
Entity Type:Organization
Organization Name:SITE GROUP, LLC
Other - Org Name:SITE FOR SORE EYES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMBRA
Authorized Official - Suffix:
Authorized Official - Credentials:RSLD
Authorized Official - Phone:510-301-8317
Mailing Address - Street 1:1833 FILLMORE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3180
Mailing Address - Country:US
Mailing Address - Phone:510-301-8317
Mailing Address - Fax:510-225-2368
Practice Address - Street 1:300 W PORTAL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-1412
Practice Address - Country:US
Practice Address - Phone:415-753-8511
Practice Address - Fax:415-753-5517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier