Provider Demographics
NPI:1679690150
Name:PACIFIC EYE SPECIALISTS
Entity Type:Organization
Organization Name:PACIFIC EYE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:650-342-4595
Mailing Address - Street 1:50 S SAN MATEO DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3859
Mailing Address - Country:US
Mailing Address - Phone:650-342-4595
Mailing Address - Fax:650-342-3932
Practice Address - Street 1:50 S SAN MATEO DR STE 200
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3859
Practice Address - Country:US
Practice Address - Phone:650-342-4595
Practice Address - Fax:650-342-3932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty