Provider Demographics
NPI:1821666546
Name:VISION ACADEMY SF- AN OPTOMETRIC CORP.
Entity Type:Organization
Organization Name:VISION ACADEMY SF- AN OPTOMETRIC CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-928-4986
Mailing Address - Street 1:361 3RD ST STE C
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3580
Mailing Address - Country:US
Mailing Address - Phone:415-459-2020
Mailing Address - Fax:415-459-2021
Practice Address - Street 1:361 3RD ST STE C
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3580
Practice Address - Country:US
Practice Address - Phone:415-459-2020
Practice Address - Fax:415-459-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Multi-Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Multi-Specialty