Provider Demographics
NPI:1578814430
Name:RIVERCITY DOCTORS OF OPTOMETRY INC.
Entity Type:Organization
Organization Name:RIVERCITY DOCTORS OF OPTOMETRY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADY
Authorized Official - Middle Name:P
Authorized Official - Last Name:REMBLESKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:916-452-2020
Mailing Address - Street 1:1315 ALHAMBRA BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5247
Mailing Address - Country:US
Mailing Address - Phone:916-452-2020
Mailing Address - Fax:916-452-3365
Practice Address - Street 1:1315 ALHAMBRA BLVD STE 310
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5247
Practice Address - Country:US
Practice Address - Phone:916-452-2020
Practice Address - Fax:916-452-3365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11947T152W00000X
CA5898T152W00000X
CA5510152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACL107BMedicare PIN