Provider Demographics
NPI:1285840488
Name:ST MARY'S EYE SPECIALISTS INC
Entity type:Organization
Organization Name:ST MARY'S EYE SPECIALISTS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAESTAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-387-8887
Mailing Address - Street 1:2250 HAYES ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1078
Mailing Address - Country:US
Mailing Address - Phone:415-387-8887
Mailing Address - Fax:415-387-3383
Practice Address - Street 1:2250 HAYES ST
Practice Address - Street 2:SUITE 208
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1078
Practice Address - Country:US
Practice Address - Phone:415-387-8887
Practice Address - Fax:415-387-3383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207W00000X
CAG53132332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ30016ZMedicare UPIN
CA5172530001Medicare NSC