Provider Demographics
NPI:1548660673
Name:TWO OPTOMETRY,INC.
Entity type:Organization
Organization Name:TWO OPTOMETRY,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JINTAU
Authorized Official - Middle Name:
Authorized Official - Last Name:TWO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:760-666-2612
Mailing Address - Street 1:5275 VISTA BLVD
Mailing Address - Street 2:A-3
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-5318
Mailing Address - Country:US
Mailing Address - Phone:760-666-2612
Mailing Address - Fax:
Practice Address - Street 1:15888 MAIN ST STE 112A
Practice Address - Street 2:CA
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3467
Practice Address - Country:US
Practice Address - Phone:760-949-2242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8606T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0086061Medicaid