Provider Demographics
NPI:1235262726
Name:SIERRA EYE OPTOMETRIC CORP
Entity Type:Organization
Organization Name:SIERRA EYE OPTOMETRIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:GERLACH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:559-636-1000
Mailing Address - Street 1:2830 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-4331
Mailing Address - Country:US
Mailing Address - Phone:559-636-1000
Mailing Address - Fax:559-733-7438
Practice Address - Street 1:2830 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4331
Practice Address - Country:US
Practice Address - Phone:559-636-1000
Practice Address - Fax:559-733-7438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT60330T152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Not Answered332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0060330Medicaid
CAT10208Medicare UPIN
CASD0060330Medicaid