| Organization Name: | MID-PENINSULA OPTICAL |
| NPI Number: | 1073649273 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DANIEL PAQUETTE (OWNER OPTICIAN) |
| Mailing Address: | 883 Santa Cruz Ave Menlo Park |
| State: | CA US |
| Postal Code: | 940254638 |
| Phone Number: | 6503244333 |
| Fax Number: | 6503244311 |
| NPI Enumeration Date: | 02/24/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FC0801X |
| License Number: | CL391 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | CA |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Contact Lens Fitter |
| Taxonomy Definition: | An optician or other ancillary support staff person who, where authorized by state law and trained or certified to do so, may fit or dispense contact lenses to a patient based on the prescription of an optometrist or medical physician. |