Provider Demographics
NPI:1518314962
Name:BERKELEY CALIFORNIA OPTOMETRIC, INC
Entity Type:Organization
Organization Name:BERKELEY CALIFORNIA OPTOMETRIC, INC
Other - Org Name:ALBANY BERKELEY OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:415-377-9004
Mailing Address - Street 1:1313 SOLANO AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1825
Mailing Address - Country:US
Mailing Address - Phone:510-526-0194
Mailing Address - Fax:510-524-2370
Practice Address - Street 1:1313 SOLANO AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1825
Practice Address - Country:US
Practice Address - Phone:510-526-0194
Practice Address - Fax:510-524-2370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11438T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty