Provider Demographics
NPI:1275519571
Name:CHICO VISION CARE OPTOMETRY GROUP
Entity Type:Organization
Organization Name:CHICO VISION CARE OPTOMETRY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:530-342-9644
Mailing Address - Street 1:2109 FOREST AVE
Mailing Address - Street 2:SUITE 50
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7680
Mailing Address - Country:US
Mailing Address - Phone:530-342-9644
Mailing Address - Fax:530-342-7547
Practice Address - Street 1:2109 FOREST AVE
Practice Address - Street 2:SUITE 50
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-7680
Practice Address - Country:US
Practice Address - Phone:530-342-9644
Practice Address - Fax:530-342-7547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 5613 TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0056130Medicaid
CASD0060770Medicaid
CA46196OtherSAFEGUARD
CACV07521OtherSPECTERA
CA116313OtherEYEMED
CA4416990001Medicare NSC
CAT10223Medicare UPIN
CASD0056130Medicaid
CACA122066Medicare PIN