Provider Demographics
NPI:1215174164
Name:ACKROYD & VAN HOOSE OPTOMETRY
Entity type:Organization
Organization Name:ACKROYD & VAN HOOSE OPTOMETRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:CAMERON
Authorized Official - Last Name:VAN HOOSE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:858-292-7193
Mailing Address - Street 1:7246 CLAIREMONT MESA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1007
Mailing Address - Country:US
Mailing Address - Phone:858-292-7193
Mailing Address - Fax:858-292-8247
Practice Address - Street 1:7246 CLAIREMONT MESA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1007
Practice Address - Country:US
Practice Address - Phone:858-292-7193
Practice Address - Fax:858-292-8247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12667T152W00000X
CA6576T152W00000X
CA4774T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABZ101AMedicare PIN