Provider Demographics
NPI:1366645285
Name:ROSEVILLE SITE FOR VISION PRODUCTS, INC.
Entity Type:Organization
Organization Name:ROSEVILLE SITE FOR VISION PRODUCTS, INC.
Other - Org Name:SITE FOR SORE EYES 572
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:RINKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-782-9985
Mailing Address - Street 1:1095 ROSEVILLE SQ
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-2809
Mailing Address - Country:US
Mailing Address - Phone:916-782-9985
Mailing Address - Fax:916-782-9987
Practice Address - Street 1:1095 ROSEVILLE SQ
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-2809
Practice Address - Country:US
Practice Address - Phone:916-782-9985
Practice Address - Fax:916-782-9987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD7262156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty