Provider Demographics
NPI:1417459264
Name:BEST BUY EYEWEAR
Entity Type:Organization
Organization Name:BEST BUY EYEWEAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:JOAQUIN
Authorized Official - Last Name:FAJARDO
Authorized Official - Suffix:
Authorized Official - Credentials:DO (DISPENSING OPT
Authorized Official - Phone:661-912-4058
Mailing Address - Street 1:PO BOX 12832
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93389-2832
Mailing Address - Country:US
Mailing Address - Phone:661-912-4058
Mailing Address - Fax:
Practice Address - Street 1:2935 OSWELL ST STE B
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-2705
Practice Address - Country:US
Practice Address - Phone:661-912-4058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty