Provider Demographics
NPI:1578145066
Name:FIRST OPTOMETRIC CARE OF NORTHERN CALIFORNIA PC
Entity Type:Organization
Organization Name:FIRST OPTOMETRIC CARE OF NORTHERN CALIFORNIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:MCPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-407-7156
Mailing Address - Street 1:100 S HARDING BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-3360
Mailing Address - Country:US
Mailing Address - Phone:916-783-8109
Mailing Address - Fax:
Practice Address - Street 1:100 S HARDING BLVD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-3360
Practice Address - Country:US
Practice Address - Phone:916-783-8109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty