1376723577 NPI number — FIRSTSIGHT VISION SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376723577 NPI number — FIRSTSIGHT VISION SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRSTSIGHT VISION SERVICES, INC.
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:
Provider Other Organization Name Type Code:
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:
1376723577
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1202 MONTE VISTA AVE STE 17
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91786-8216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-920-5008
Provider Business Mailing Address Fax Number:
888-241-9266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2663 CANYON SPRINGS PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92507-0911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-656-7218
Provider Business Practice Location Address Fax Number:
951-697-8165
Provider Enumeration Date:
11/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HEIDELMAN
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
909-920-5008

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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