Provider Demographics
NPI:1356813711
Name:TOTAL VISION PC
Entity Type:Organization
Organization Name:TOTAL VISION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, REVENUE CYCLE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-652-7233
Mailing Address - Street 1:23282 MILL CREEK DR STE 225
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1678
Mailing Address - Country:US
Mailing Address - Phone:949-562-7233
Mailing Address - Fax:
Practice Address - Street 1:11717 BERNARDO PLAZA CT STE 105
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2419
Practice Address - Country:US
Practice Address - Phone:858-487-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-26
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty