Provider Demographics
NPI:1629226063
Name:VISIONS OPTOMETRY
Entity Type:Organization
Organization Name:VISIONS OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:949-768-4601
Mailing Address - Street 1:24351 AVENIDA DE LA CARLOTA
Mailing Address - Street 2:SUITE N-3
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3656
Mailing Address - Country:US
Mailing Address - Phone:949-768-4601
Mailing Address - Fax:949-768-7582
Practice Address - Street 1:24351 AVENIDA DE LA CARLOTA
Practice Address - Street 2:SUITE N-3
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3656
Practice Address - Country:US
Practice Address - Phone:949-768-4601
Practice Address - Fax:949-768-7582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 10279 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty