Provider Demographics
NPI:1003957705
Name:JON SILLS
Entity Type:Organization
Organization Name:JON SILLS
Other - Org Name:FAMILY VISION OPTOMETRIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:SILLS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:805-642-4185
Mailing Address - Street 1:4601 TELEPHONE RD STE 109
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5671
Mailing Address - Country:US
Mailing Address - Phone:805-642-4185
Mailing Address - Fax:805-647-7467
Practice Address - Street 1:4601 TELEPHONE RD STE 109
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5671
Practice Address - Country:US
Practice Address - Phone:805-642-4185
Practice Address - Fax:805-647-7467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6804152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3364OtherMEDICAL EYE SERVICES
CAW14935Medicare PIN
CAX50700Medicare UPIN
CA0325380001Medicare NSC