Provider Demographics
NPI:1285658872
Name:VACAVILLE OPTOMETRIC VISION CENTER INC.
Entity Type:Organization
Organization Name:VACAVILLE OPTOMETRIC VISION CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ENGLERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-448-3451
Mailing Address - Street 1:513 MERCHANT ST
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-4511
Mailing Address - Country:US
Mailing Address - Phone:707-448-3451
Mailing Address - Fax:707-448-1304
Practice Address - Street 1:513 MERCHANT ST
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4511
Practice Address - Country:US
Practice Address - Phone:707-448-3451
Practice Address - Fax:707-448-1304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD000980Medicaid
CAGSD000980Medicaid
CA0694850001Medicare NSC