Provider Demographics
NPI:1871650689
Name:GRASS VALLEY EYE CARE OPTOMETRIC, INC.
Entity Type:Organization
Organization Name:GRASS VALLEY EYE CARE OPTOMETRIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARKIS-MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:530-273-6000
Mailing Address - Street 1:998 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-9532
Mailing Address - Country:US
Mailing Address - Phone:530-273-6000
Mailing Address - Fax:530-272-8459
Practice Address - Street 1:998 PLAZA DR
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-9532
Practice Address - Country:US
Practice Address - Phone:530-273-6000
Practice Address - Fax:530-272-8459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10668TPG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5188580001Medicare NSC
CAZZZ29801ZMedicare PIN