Provider Demographics
NPI:1184287641
Name:YOUR TWO EYES OPTOMETRY INC.
Entity type:Organization
Organization Name:YOUR TWO EYES OPTOMETRY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMII
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-926-2102
Mailing Address - Street 1:2110 VINE ST STE B
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-1577
Mailing Address - Country:US
Mailing Address - Phone:510-540-5555
Mailing Address - Fax:510-548-3999
Practice Address - Street 1:2110 VINE ST STE B
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-1577
Practice Address - Country:US
Practice Address - Phone:510-540-5555
Practice Address - Fax:510-548-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty