Provider Demographics
NPI:1629359757
Name:VISION CENTRE OF VICTOR VALLEY INC
Entity Type:Organization
Organization Name:VISION CENTRE OF VICTOR VALLEY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:760-951-2516
Mailing Address - Street 1:14400 BEAR VALLEY ROAD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-5406
Mailing Address - Country:US
Mailing Address - Phone:760-951-2516
Mailing Address - Fax:760-955-2227
Practice Address - Street 1:14400 BEAR VALLEY ROAD
Practice Address - Street 2:SUITE 204
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-5406
Practice Address - Country:US
Practice Address - Phone:760-951-2516
Practice Address - Fax:760-955-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-02
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA9940T332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier