Provider Demographics
NPI:1053513770
Name:EYES OF THE AVENUE, INC.
Entity type:Organization
Organization Name:EYES OF THE AVENUE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSSEINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-624-1438
Mailing Address - Street 1:479 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-1814
Mailing Address - Country:US
Mailing Address - Phone:650-327-2020
Mailing Address - Fax:650-327-2039
Practice Address - Street 1:479 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-1814
Practice Address - Country:US
Practice Address - Phone:650-327-2020
Practice Address - Fax:650-327-2039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty