Provider Demographics
NPI:1164017646
Name:FIRST OPTOMETRIC CARE OF NORTHERN CALIFORNIA PC
Entity Type:Organization
Organization Name:FIRST OPTOMETRIC CARE OF NORTHERN CALIFORNIA PC
Other - Org Name:STANISLAUS OPTOMETRIC CENTER INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:MCPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-407-7156
Mailing Address - Street 1:4028 DALE RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9561
Mailing Address - Country:US
Mailing Address - Phone:209-791-8001
Mailing Address - Fax:
Practice Address - Street 1:4028 DALE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9561
Practice Address - Country:US
Practice Address - Phone:209-791-8001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-05
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty