Provider Demographics
NPI:1851334965
Name:CHILD, VICTOR F (OD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:F
Last Name:CHILD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14550 MONO WAY
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-8852
Mailing Address - Country:US
Mailing Address - Phone:209-532-7192
Mailing Address - Fax:209-532-5836
Practice Address - Street 1:14550 MONO WAY
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-8852
Practice Address - Country:US
Practice Address - Phone:209-532-7192
Practice Address - Fax:209-532-5836
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMC1115434152W00000X, 152WC0802X, 152WL0500X, 152WX0102X, 152WP0200X, 152WS0006X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAP876ZMedicare PIN