Provider Demographics
NPI:1740428580
Name:ADVANCED EYECARE, AN OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:ADVANCED EYECARE, AN OPTOMETRIC CORPORATION
Other - Org Name:NU VISION OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUKHDEEP
Authorized Official - Middle Name:S
Authorized Official - Last Name:TAKHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:530-415-6565
Mailing Address - Street 1:1145 COLUSA AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3630
Mailing Address - Country:US
Mailing Address - Phone:530-751-1325
Mailing Address - Fax:530-751-0639
Practice Address - Street 1:1145 COLUSA AVE
Practice Address - Street 2:SUITE C
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3630
Practice Address - Country:US
Practice Address - Phone:530-751-1325
Practice Address - Fax:530-751-0639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12688T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6305100001Medicare NSC
CABP430AMedicare PIN