Provider Demographics
NPI:1578184040
Name:VASQUEZ, EMIKO (OD)
Entity Type:Individual
Prefix:
First Name:EMIKO
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19090 RAVENSWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-9040
Mailing Address - Country:US
Mailing Address - Phone:510-896-9404
Mailing Address - Fax:
Practice Address - Street 1:10601 PECAN PARK BLVD STE 201
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1325
Practice Address - Country:US
Practice Address - Phone:512-402-6136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT34555TLG152W00000X
390200000X
TX100096T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program