Provider Demographics
NPI:1376506618
Name:FOGG REMINGTON EYECARE, INC.
Entity Type:Organization
Organization Name:FOGG REMINGTON EYECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-226-3975
Mailing Address - Street 1:1360 E HERNDON AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3326
Mailing Address - Country:US
Mailing Address - Phone:559-449-5010
Mailing Address - Fax:559-449-5014
Practice Address - Street 1:1817 SHAW AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-4069
Practice Address - Country:US
Practice Address - Phone:559-449-5010
Practice Address - Fax:559-449-5014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-08
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0078921Medicaid
CAGSD004052Medicaid
CA1304310004OtherCIGNA MEDICARE DMERC
CAGR0078921Medicaid