Organization
I TO I LLC
Active
Other names
My Eyelab
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE BENNETT (CREDENTIALING MANAGER)
(619) 357-6146
Entity
Organization
Contact information
Practice address
3401 OAKDALE RD, STE 525, MODESTO, CA 95355
(209) 662-0282
(561) 828-8367
Mailing address
3401 OAKDALE RD, STE 525, MODESTO, CA 95355
(209) 662-0282
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
332H00000X
Eyewear Supplier
—
—
Other
Enumeration date
09/25/2020
Last updated
02/17/2021
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