1740428580 NPI number — ADVANCED EYECARE, AN OPTOMETRIC CORPORATION

Table of content: (NPI 1740428580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740428580 NPI number — ADVANCED EYECARE, AN OPTOMETRIC CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED EYECARE, AN OPTOMETRIC CORPORATION
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:
6
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:
1740428580
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1145 COLUSA AVE
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
YUBA CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95991-3630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-751-1325
Provider Business Mailing Address Fax Number:
530-751-0639

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1145 COLUSA AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
YUBA CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95991-3630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-751-1325
Provider Business Practice Location Address Fax Number:
530-751-0639
Provider Enumeration Date:
02/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
TAKHER
Authorized Official First Name:
SUKHDEEP
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OPTOMETRIST/OWNER
Authorized Official Telephone Number:
530-415-6565

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  12688T , 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)





Copyright © 2007-2025 www.npivalidator.com