Provider Demographics
NPI:1831527811
Name:WESTLAKE VISION CENTER OPTOMETRY INC, A PROF OPTOMETRIC CORP
Entity type:Organization
Organization Name:WESTLAKE VISION CENTER OPTOMETRY INC, A PROF OPTOMETRIC CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:NOMURA
Authorized Official - Last Name:YAMADA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:925-360-1384
Mailing Address - Street 1:326 WESTLAKE CTR
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-1431
Mailing Address - Country:US
Mailing Address - Phone:650-992-2020
Mailing Address - Fax:650-992-1105
Practice Address - Street 1:326 WESTLAKE CTR
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1431
Practice Address - Country:US
Practice Address - Phone:650-992-2020
Practice Address - Fax:650-992-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7392T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA123020OtherPTAN
CA123022OtherPTAN
1639272669OtherNPI
CA122924OtherPTAN