Provider Demographics
NPI:1770017642
Name:GOLETA VALLEY OPTOMETRY INC
Entity Type:Organization
Organization Name:GOLETA VALLEY OPTOMETRY INC
Other - Org Name:GOLETA VALLEY OPTOMETRY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MAJORITY OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:BREAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:805-451-8180
Mailing Address - Street 1:5122 HOLLISTER AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2526
Mailing Address - Country:US
Mailing Address - Phone:805-451-8180
Mailing Address - Fax:805-456-1994
Practice Address - Street 1:5122 HOLLISTER AVE
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2526
Practice Address - Country:US
Practice Address - Phone:805-451-8180
Practice Address - Fax:805-456-1994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
CA10171TLG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA815200949OtherEIN