Provider Demographics
NPI:1346576295
Name:EYECENTER OPTOMETRICS, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:EYECENTER OPTOMETRICS, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMUNICATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:L
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-726-1818
Mailing Address - Street 1:5959 GREENBACK LN
Mailing Address - Street 2:SUITE # 130
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621-9562
Mailing Address - Country:US
Mailing Address - Phone:916-852-1600
Mailing Address - Fax:916-852-0231
Practice Address - Street 1:2200 SUNRISE BLVD
Practice Address - Street 2:SUITE #120
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-4374
Practice Address - Country:US
Practice Address - Phone:916-852-1600
Practice Address - Fax:916-852-0231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABOL6465152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ50558ZOtherBCBS
CAGSD001121Medicaid
CAGSD001121Medicaid