Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPT34675-TLG | CA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OPT002945 | GA |
N | 152WX0102X | Occupational Vision | OPT002945 | GA |
NPI | 1114377173 |
---|---|
Provider Name | Dr. Carlos Eduardo Pessoa |
First Address | Porterville, CA 93257 |
Second Address | Porterville, CA 93257 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2016 |
Last Update Date | 04/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OPT34675-TLG | CALIFORNIA BOARD OF OPTOMETRY (01) | CA |