Provider Demographics
NPI:1376871608
Name:VISION FX OPTOMETRIC SERVICES INC
Entity Type:Organization
Organization Name:VISION FX OPTOMETRIC SERVICES INC
Other - Org Name:VISION FX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-449-7669
Mailing Address - Street 1:2465 DISCOVERY BAY BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:DISCOVERY BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94505-1009
Mailing Address - Country:US
Mailing Address - Phone:925-626-7070
Mailing Address - Fax:925-626-7061
Practice Address - Street 1:2465 DISCOVERY BAY BLVD STE 201
Practice Address - Street 2:
Practice Address - City:DISCOVERY BAY
Practice Address - State:CA
Practice Address - Zip Code:94505-1009
Practice Address - Country:US
Practice Address - Phone:925-626-7070
Practice Address - Fax:925-626-7061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13393152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA115334Medicare PIN