| NPI | 1902967516 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON GORDON WADA Owner 408-243-7916 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 9115) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA 9115) |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: CA 9115) | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2015-05-15 |