1780774596 NPI number — THE VISION CENTER AN OPTOMETRIC PRACTICE INCORPORATED

Table of content: (NPI 1780774596)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780774596 NPI number — THE VISION CENTER AN OPTOMETRIC PRACTICE INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE VISION CENTER AN OPTOMETRIC PRACTICE INCORPORATED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE VISION CENTER, AN OPTOMETRIC PRACTICE, INC.
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780774596
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26506 BOUQUET CANYON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAUGUS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91350-2353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-297-2020
Provider Business Mailing Address Fax Number:
661-297-3380

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26506 BOUQUET CANYON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAUGUS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91350-2353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-297-2020
Provider Business Practice Location Address Fax Number:
661-297-3380
Provider Enumeration Date:
10/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
UMEMOTO
Authorized Official First Name:
LARA
Authorized Official Middle Name:
MIEKO
Authorized Official Title or Position:
OPTOMETRIST, OWNER, PRESIDENT
Authorized Official Telephone Number:
661-297-2020

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4873T , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AO571Z . This is a "MEDICARE PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GSD004840 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: SD0109840 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".