Provider Demographics
NPI:1881825081
Name:GENE SERPA'S LUXTON OPTICAL CO,INC
Entity Type:Organization
Organization Name:GENE SERPA'S LUXTON OPTICAL CO,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SERPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-461-9222
Mailing Address - Street 1:212 BON AIR CTR
Mailing Address - Street 2:
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2416
Mailing Address - Country:US
Mailing Address - Phone:415-461-9222
Mailing Address - Fax:415-461-3958
Practice Address - Street 1:212 BON AIR CTR
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2416
Practice Address - Country:US
Practice Address - Phone:415-461-9222
Practice Address - Fax:415-461-3958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1956332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0226420001Medicare NSC