| NPI | 1427919729 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MACSON LEE CEO, Od, Fovdra 650-521-4570 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics |
| 152WS0006X Optometrist, Sports Vision | |
| 152WV0400X Optometrist, Vision Therapy | |
| Enumeration Date | 2025-11-18 |
| Last Update Date | 2025-11-18 |