Provider Demographics
NPI:1760670624
Name:BALFOUR VISION OPTIX OPTOMETRY INC.
Entity Type:Organization
Organization Name:BALFOUR VISION OPTIX OPTOMETRY INC.
Other - Org Name:LONE TREE VISION OPTIX OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WINSON
Authorized Official - Middle Name:
Authorized Official - Last Name:ONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:925-513-0323
Mailing Address - Street 1:3840 BALFOUR RD STE A
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1641
Mailing Address - Country:US
Mailing Address - Phone:925-513-0323
Mailing Address - Fax:
Practice Address - Street 1:5113 LONE TREE WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8484
Practice Address - Country:US
Practice Address - Phone:925-778-1505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BALFOUR VISION OPTIX OPTOMETRY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-04
Last Update Date:2019-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0119381Medicaid
CASD0119381Medicaid
CAU92137Medicare UPIN