Provider Demographics
NPI:1770920407
Name:DOWNTOWN VACAVILLE EYECARE, INC AN OPTOMETRIC CORPORATION
Entity type:Organization
Organization Name:DOWNTOWN VACAVILLE EYECARE, INC AN OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HANG
Authorized Official - Middle Name:T
Authorized Official - Last Name:NHAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:707-446-2090
Mailing Address - Street 1:340 CERNON ST
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-4502
Mailing Address - Country:US
Mailing Address - Phone:707-446-2090
Mailing Address - Fax:707-446-4406
Practice Address - Street 1:340 CERNON ST
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4502
Practice Address - Country:US
Practice Address - Phone:707-446-2090
Practice Address - Fax:707-446-4406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-04
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11196T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty