Provider Demographics
NPI:1649483538
Name:EYES ON GRACE
Entity type:Organization
Organization Name:EYES ON GRACE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRYNHOL
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:HOLSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-276-6000
Mailing Address - Street 1:15100 HESPERIAN BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-3638
Mailing Address - Country:US
Mailing Address - Phone:510-276-6000
Mailing Address - Fax:510-317-0306
Practice Address - Street 1:15100 HESPERIAN BLVD STE 120
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-3638
Practice Address - Country:US
Practice Address - Phone:510-276-6000
Practice Address - Fax:510-317-0306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD7111156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty