Provider Demographics
NPI:1174937999
Name:CHILDREN'S EYE CARE OF LOS GATOS, INC., A PROFESSIONAL CORP.
Entity type:Organization
Organization Name:CHILDREN'S EYE CARE OF LOS GATOS, INC., A PROFESSIONAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRECKENRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-399-9009
Mailing Address - Street 1:250 ALMENDRA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-7211
Mailing Address - Country:US
Mailing Address - Phone:408-399-9009
Mailing Address - Fax:408-399-9073
Practice Address - Street 1:250 ALMENDRA AVE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-7211
Practice Address - Country:US
Practice Address - Phone:408-399-9009
Practice Address - Fax:408-399-9073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus SpecialistGroup - Single Specialty