Provider Demographics
NPI:1083874218
Name:PARAM S FAGOORA MD INC
Entity Type:Organization
Organization Name:PARAM S FAGOORA MD INC
Other - Org Name:CLEAR VISION MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PARAMJIT
Authorized Official - Middle Name:S
Authorized Official - Last Name:FAGOORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-439-2040
Mailing Address - Street 1:5359 N FRESNO ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-6831
Mailing Address - Country:US
Mailing Address - Phone:559-439-2040
Mailing Address - Fax:877-425-1429
Practice Address - Street 1:5359 N FRESNO ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-6831
Practice Address - Country:US
Practice Address - Phone:559-439-2040
Practice Address - Fax:877-425-1429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A304860207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A304860Medicaid
CA00A304860Medicaid
CAA26126Medicare UPIN