Provider Demographics
NPI:1700941853
Name:PENZA & MORIOKA OPTOMETRY INC
Entity Type:Organization
Organization Name:PENZA & MORIOKA OPTOMETRY INC
Other - Org Name:PENZA & MORIOKA
Other - Org Type:Other Name
Authorized Official - Title/Position:AUTHORIZED AND DELEGATED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:PENZA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:415-291-8560
Mailing Address - Street 1:530 BUSH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108
Mailing Address - Country:US
Mailing Address - Phone:415-291-8560
Mailing Address - Fax:415-291-8573
Practice Address - Street 1:530 BUSH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108
Practice Address - Country:US
Practice Address - Phone:415-291-8560
Practice Address - Fax:415-291-8573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT8305TPA152W00000X
CAOPT8287TPA152W00000X
CA11219TCA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ08419ZOtherBLUE SHIELD
CAZZZ08419ZOtherBLUE SHIELD