Provider Demographics
NPI:1790033421
Name:ALL EYES ON YOU OPTOMETRY INC
Entity Type:Organization
Organization Name:ALL EYES ON YOU OPTOMETRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:NURISIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-592-1820
Mailing Address - Street 1:336 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-2408
Mailing Address - Country:US
Mailing Address - Phone:650-592-1820
Mailing Address - Fax:
Practice Address - Street 1:336 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-2408
Practice Address - Country:US
Practice Address - Phone:650-592-1820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADU0445OtherRAILROAD MEDICARE
CAGO214AOtherPTAN
CA1790033421Medicare PIN
CADU0445Medicare PIN