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Organization

SYLVAN EYE ASSOCIATES, A MEDICAL CORPORATION

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KERRY ALAN HORNER OD (VICE PRESIDENT)
(209) 575-2020
Entity
Organization

Contact information

Practice address
1011 SYLVAN AVE, SUITE A, MODESTO, CA 95350-1692
(209) 575-2020
(209) 758-5693
Mailing address
1011 SYLVAN AVE, SUITE A, MODESTO, CA 95350-1692
(209) 575-2020
(209) 758-5693

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
207W00000X
Ophthalmology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
GR0088410
OPTHALMOLOGY MEDICAL
CA
05
GSD088411
CA
01
ZZZ00823Z
BLUE SHIELD
Enumeration date
10/18/2005
Last updated
01/25/2011
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