| NPI | 1649448507 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH H BALLENTINE Doctor 408-255-0576 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: CA 6863T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 6863T) |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2012-09-06 |