Provider Demographics
NPI:1689158453
Name:VAIL RANCH VISION INC
Entity Type:Organization
Organization Name:VAIL RANCH VISION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:UTNEHMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-541-7157
Mailing Address - Street 1:31805 TEMECULA PKWY STE D-5
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-8200
Mailing Address - Country:US
Mailing Address - Phone:951-383-4104
Mailing Address - Fax:
Practice Address - Street 1:40764 WINCHESTER RD STE 580
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-6502
Practice Address - Country:US
Practice Address - Phone:951-541-3427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty