Provider Demographics
NPI:1104395722
Name:ADVANCED OPTOMETRIC SERVICES INC
Entity Type:Organization
Organization Name:ADVANCED OPTOMETRIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:209-628-0110
Mailing Address - Street 1:5942 ARENA WAY
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:CA
Mailing Address - Zip Code:95334-9314
Mailing Address - Country:US
Mailing Address - Phone:209-628-0110
Mailing Address - Fax:
Practice Address - Street 1:1208 FLOYD AVE BLDG C
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-2470
Practice Address - Country:US
Practice Address - Phone:209-521-7771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-14
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty