Provider Demographics
NPI:1497049043
Name:TRIBAL EYES
Entity type:Organization
Organization Name:TRIBAL EYES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CLD SLD RDO FNAO
Authorized Official - Phone:510-361-8879
Mailing Address - Street 1:6207 MAJESTIC AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-1860
Mailing Address - Country:US
Mailing Address - Phone:510-361-8879
Mailing Address - Fax:
Practice Address - Street 1:160 FRANKLIN STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-3759
Practice Address - Country:US
Practice Address - Phone:510-268-8091
Practice Address - Fax:510-268-8093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-31
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD7655332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA28010222OtherCITY OF OAKLAND BUSINESS LICENSE
CAC3388261OtherSECRETARY OF STATE CORPORATION FILE NUMBER
CAD7655OtherMEDICAL BOARD, REGISTERED DISPENSING OPTICIAN
CA28010222OtherCITY OF OAKLAND BUSINESS LICENSE