Provider Demographics
NPI:1720629819
Name:EYES LOVE 20/20 OPTOMETRY, INC.
Entity Type:Organization
Organization Name:EYES LOVE 20/20 OPTOMETRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-244-9938
Mailing Address - Street 1:PO BOX 4148
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95150-4148
Mailing Address - Country:US
Mailing Address - Phone:714-244-9938
Mailing Address - Fax:
Practice Address - Street 1:1020 EL PASEO DE SARATOGA
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95130-1630
Practice Address - Country:US
Practice Address - Phone:408-364-9988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty