Provider Demographics
NPI:1588710305
Name:JEFFREY A HOLBERT O D A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JEFFREY A HOLBERT O D A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HOLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:408-245-5725
Mailing Address - Street 1:320 W EL CAMINO REAL
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-1306
Mailing Address - Country:US
Mailing Address - Phone:408-245-5725
Mailing Address - Fax:408-356-1271
Practice Address - Street 1:320 W EL CAMINO REAL
Practice Address - Street 2:SUITE B-1
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-1306
Practice Address - Country:US
Practice Address - Phone:408-245-5725
Practice Address - Fax:408-356-1271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05876T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0058760Medicare UPIN