Provider Demographics
NPI:1548317159
Name:SUNNYVALE VISION AND EYE CARE CENTER, INC.
Entity type:Organization
Organization Name:SUNNYVALE VISION AND EYE CARE CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT - OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:FOLKERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:408-739-3937
Mailing Address - Street 1:510 S MURPHY AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-6116
Mailing Address - Country:US
Mailing Address - Phone:408-739-3937
Mailing Address - Fax:408-739-5355
Practice Address - Street 1:510 S MURPHY AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-6116
Practice Address - Country:US
Practice Address - Phone:408-739-3937
Practice Address - Fax:408-739-5355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10629152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ29931ZMedicare ID - Type UnspecifiedMEDICARE GROUP #
CA0663110001Medicare NSC