Provider Demographics
NPI:1568804771
Name:ULTIMATE VISION CARE
Entity Type:Organization
Organization Name:ULTIMATE VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YURY
Authorized Official - Middle Name:
Authorized Official - Last Name:RONIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:682-554-2079
Mailing Address - Street 1:5860 N TARRANT PKWY
Mailing Address - Street 2:108
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-7201
Mailing Address - Country:US
Mailing Address - Phone:817-656-0440
Mailing Address - Fax:
Practice Address - Street 1:5860 N TARRANT PKWY
Practice Address - Street 2:108
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-7201
Practice Address - Country:US
Practice Address - Phone:817-656-0440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8032TG261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery