Provider Demographics
NPI:1306497888
Name:NEWPORT AVENUE OPTOMETRY INC.
Entity type:Organization
Organization Name:NEWPORT AVENUE OPTOMETRY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:ELI
Authorized Official - Middle Name:
Authorized Official - Last Name:BEN MOSHE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:619-222-0559
Mailing Address - Street 1:4822 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-3111
Mailing Address - Country:US
Mailing Address - Phone:619-222-0559
Mailing Address - Fax:619-222-0231
Practice Address - Street 1:4822 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-3111
Practice Address - Country:US
Practice Address - Phone:619-222-0559
Practice Address - Fax:619-222-0231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-25
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty