Provider Demographics
NPI:1861839862
Name:HMB OPTOMETRIC GROUP LLC
Entity Type:Organization
Organization Name:HMB OPTOMETRIC GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSHASHA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:202-425-8663
Mailing Address - Street 1:393 EAGLE TRACE DR
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-2291
Mailing Address - Country:US
Mailing Address - Phone:202-425-8663
Mailing Address - Fax:
Practice Address - Street 1:80 CABRILLO HWY N
Practice Address - Street 2:SUITE J
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-1650
Practice Address - Country:US
Practice Address - Phone:650-726-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13921152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty