Provider Demographics
NPI:1396967626
Name:HARBOR BAY OPTOMETRY DBA ALAMEDA EYES OPTOMETRY
Entity type:Organization
Organization Name:HARBOR BAY OPTOMETRY DBA ALAMEDA EYES OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER ABO
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-814-7268
Mailing Address - Street 1:1432 PARK ST
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4510
Mailing Address - Country:US
Mailing Address - Phone:510-769-2020
Mailing Address - Fax:510-769-7912
Practice Address - Street 1:1432 PARK ST
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4510
Practice Address - Country:US
Practice Address - Phone:510-769-2020
Practice Address - Fax:510-769-7912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8198T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8198TOtherLICENSE
CA8198TOtherLICENSE
CASD0081980Medicare ID - Type Unspecified