| NPI | 1164639456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVAN MATTHEW ROBERTS Sole Proprietor 619-722-6121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 8120T) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA 8120T) |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: CA 8120T) | |
| 152WP0200X Optometrist, Pediatrics (Licence: CA 8120T) | |
| 152WS0006X Optometrist, Sports Vision (Licence: CA 8120T) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: CA 8120T) | |
| 152WX0102X Optometrist, Occupational Vision (Licence: CA 8120T) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2020-08-22 |