Provider Demographics
NPI:1629348313
Name:EYE 2 EYE FAMILY OPTOMETRY, PC
Entity Type:Organization
Organization Name:EYE 2 EYE FAMILY OPTOMETRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KARRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:916-349-2006
Mailing Address - Street 1:5732 WATT AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-4752
Mailing Address - Country:US
Mailing Address - Phone:916-349-2006
Mailing Address - Fax:916-349-2041
Practice Address - Street 1:5732 WATT AVE
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-4752
Practice Address - Country:US
Practice Address - Phone:916-349-2006
Practice Address - Fax:916-349-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FW154AMedicare PIN