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Organization
NIPOMO OPTOMETRY INC
Active
Organization
NIPOMO OPTOMETRY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EILEEN OTTAVIANI O.D. (OPTOMETRIST)
(805) 929-1982
Entity
Organization
Contact information
Practice address
125 S FRONTAGE RD, NIPOMO, CA 93444-8979
(805) 929-1982
Mailing address
PO BOX 1423, NIPOMO, CA 93444-1423
(805) 929-1982
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
10723T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0107230
—
CA
Enumeration date
06/28/2008
Last updated
06/28/2008
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