Provider Demographics
NPI:1306921457
Name:PLAZA LANE OPTOMETRY
Entity type:Organization
Organization Name:PLAZA LANE OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEYANO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:831-429-2020
Mailing Address - Street 1:1537 PACIFIC AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3942
Mailing Address - Country:US
Mailing Address - Phone:831-429-2020
Mailing Address - Fax:831-429-2945
Practice Address - Street 1:1537 PACIFIC AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3942
Practice Address - Country:US
Practice Address - Phone:831-429-2020
Practice Address - Fax:831-429-2945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT7576TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty