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Organization
LARRY R FABIAN & JEFFREY M FANNELLI PTRS WESTSIDE FAMILY VISION CENTER
Active
Organization
LARRY R FABIAN & JEFFREY M FANNELLI PTRS WESTSIDE FAMILY VISION CENTER
Active
Other names
Westside Family Vision Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY MARTIN FANELLI OD (OPTOMETRIST)
(408) 264-1555
Entity
Organization
Contact information
Practice address
1817 HAMILTON AVENUE, SAN JOSE, CA 95125-5624
(408) 264-1555
(408) 264-1562
Mailing address
1817 HAMILTON AVENUE, SAN JOSE, CA 95125-5624
(408) 264-1555
(408) 264-1562
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0518290001
MEDICARE SUPPLIER NUMBER
—
01
—
410044713
RAILROAD M/C - FABIAN
CA
01
—
410044714
RAILROAD M/C - FANELLI
CA
Enumeration date
09/12/2006
Last updated
07/23/2008
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