Provider Demographics
NPI:1427578327
Name:MONTEZ, EMMA KIM (OD)
Entity type:Individual
Prefix:DR
First Name:EMMA
Middle Name:KIM
Last Name:MONTEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 HARRISON ST, 7TH FL
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3429
Mailing Address - Country:US
Mailing Address - Phone:650-742-2000
Mailing Address - Fax:877-738-4262
Practice Address - Street 1:1800 HARRISON ST, 7TH FL
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3429
Practice Address - Country:US
Practice Address - Phone:650-742-2000
Practice Address - Fax:877-738-4262
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33703152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist