Provider Demographics
NPI:1245369024
Name:EYE CENTER OPTOMETRICS, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:EYE CENTER OPTOMETRICS, A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMMUNICATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:L
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-726-1818
Mailing Address - Street 1:5959 GREENBACK LN
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621-4700
Mailing Address - Country:US
Mailing Address - Phone:916-726-1818
Mailing Address - Fax:916-726-1822
Practice Address - Street 1:5959 GREENBACK LN
Practice Address - Street 2:SUITE 130
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-4700
Practice Address - Country:US
Practice Address - Phone:916-726-1818
Practice Address - Fax:916-726-1822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACOR 1075152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ50558ZOtherBLUE SHIELD PIN
CAZZZ69113ZOtherBLUE SHIELD PIN
CAGSD001121Medicaid
CAGSD001120Medicaid
CAGSD001122Medicaid
CAZZZ50557ZOtherBLUE SHIELD PIN
CAGSD001120Medicaid
CAZZZ30716ZMedicare PIN
CAZZZ50558ZOtherBLUE SHIELD PIN
CAT10160Medicare UPIN
CAT10169Medicare UPIN
CAZZZ69113ZOtherBLUE SHIELD PIN
CAU34524Medicare UPIN
CAZZZ30715ZMedicare PIN
CAU03032Medicare UPIN
CAU98364Medicare UPIN
CAZZZ30718ZMedicare ID - Type Unspecified
CAU76797Medicare UPIN
CAGSD001120Medicaid
CA5171970002Medicare NSC