Provider Demographics
NPI:1760990980
Name:MARQUEE EYECARE CENTER OF BERKELEY INC
Entity Type:Organization
Organization Name:MARQUEE EYECARE CENTER OF BERKELEY INC
Other - Org Name:SITE FOR SORE EYES # 503
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:K
Authorized Official - Last Name:KARANJA
Authorized Official - Suffix:
Authorized Official - Credentials:RSLD
Authorized Official - Phone:415-419-4616
Mailing Address - Street 1:2174 SHATTUCK AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1307
Mailing Address - Country:US
Mailing Address - Phone:510-841-6963
Mailing Address - Fax:510-548-1822
Practice Address - Street 1:2174 SHATTUCK AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1307
Practice Address - Country:US
Practice Address - Phone:510-841-6963
Practice Address - Fax:510-548-1822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASL6399156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty