Provider Demographics
NPI:1902815194
Name:VISIONARY OPTOMETRY INC.
Entity Type:Organization
Organization Name:VISIONARY OPTOMETRY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-372-5213
Mailing Address - Street 1:1200 ARTESIA BLVD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2755
Mailing Address - Country:US
Mailing Address - Phone:310-372-5213
Mailing Address - Fax:
Practice Address - Street 1:1200 ARTESIA BLVD
Practice Address - Street 2:SUITE #1
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2755
Practice Address - Country:US
Practice Address - Phone:310-372-5213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACOR 844152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4285400001Medicare NSC