Provider Demographics
NPI:1376262782
Name:TRUCKEE FAMILY EYECARE OPTOMETRY, INC
Entity Type:Organization
Organization Name:TRUCKEE FAMILY EYECARE OPTOMETRY, INC
Other - Org Name:TRUCKEE FAMILY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:530-587-1086
Mailing Address - Street 1:10038 MEADOW WAY UNIT A
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-4974
Mailing Address - Country:US
Mailing Address - Phone:530-587-1086
Mailing Address - Fax:530-582-1929
Practice Address - Street 1:10038 MEADOW WAY UNIT A
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4974
Practice Address - Country:US
Practice Address - Phone:530-587-1086
Practice Address - Fax:530-582-1929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-26
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty