Provider Demographics
NPI:1043640675
Name:CUPERTINO VILLAGE OPTOMETRY, APC
Entity type:Organization
Organization Name:CUPERTINO VILLAGE OPTOMETRY, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KAI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-873-1718
Mailing Address - Street 1:10969 N WOLFE RD
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-0617
Mailing Address - Country:US
Mailing Address - Phone:408-873-1718
Mailing Address - Fax:408-873-1026
Practice Address - Street 1:10969 N WOLFE RD
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-0617
Practice Address - Country:US
Practice Address - Phone:408-873-1718
Practice Address - Fax:408-873-1026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12434TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty