Provider Demographics
NPI:1588205298
Name:RANCHO VISION CENTER OPTOMETRY INC
Entity Type:Organization
Organization Name:RANCHO VISION CENTER OPTOMETRY INC
Other - Org Name:JOANNE J. KIM O.D. OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OD
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:JI YUN
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:909-987-0728
Mailing Address - Street 1:10165 FOOTHILL BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-0341
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10165 FOOTHILL BLVD STE 6
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0341
Practice Address - Country:US
Practice Address - Phone:909-987-0728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty