Provider Demographics
NPI:1558417428
Name:EYE CONNECTION INCORPORATED
Entity Type:Organization
Organization Name:EYE CONNECTION INCORPORATED
Other - Org Name:SITE FOR SORE EYES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DISPENSING OPTICIAN
Authorized Official - Phone:415-897-3377
Mailing Address - Street 1:208 VINTAGE WAY STE K11
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-5058
Mailing Address - Country:US
Mailing Address - Phone:415-897-3377
Mailing Address - Fax:415-897-5722
Practice Address - Street 1:208 VINTAGE WAY STE K11
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5058
Practice Address - Country:US
Practice Address - Phone:415-897-3377
Practice Address - Fax:415-897-5722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACL648156FC0801X
CASL1717156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Single Specialty
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADX006683FOtherMEDICAL