Provider Demographics
NPI:1114226776
Name:VISIONCARE OF CALIFORNIA
Entity Type:Organization
Organization Name:VISIONCARE OF CALIFORNIA
Other - Org Name:STERLING VISIONCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHASHATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-454-4647
Mailing Address - Street 1:9625 BLACK MOUNTAIN RD
Mailing Address - Street 2:311
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4564
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1138 NEWPARK MALL
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-5246
Practice Address - Country:US
Practice Address - Phone:510-790-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMERGING VISION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty