Provider Demographics
NPI:1649470741
Name:BALFOUR VISION OPTIX OPTOMETRY, INC.
Entity type:Organization
Organization Name:BALFOUR VISION OPTIX OPTOMETRY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WINSON
Authorized Official - Middle Name:
Authorized Official - Last Name:ONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:925-513-0323
Mailing Address - Street 1:3840 BALFOUR RD STE A
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1641
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3840 BALFOUR RD STE A
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-1641
Practice Address - Country:US
Practice Address - Phone:925-513-0323
Practice Address - Fax:925-513-8649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0119381Medicaid
CASD0119381Medicare ID - Type Unspecified
CAU92137Medicare UPIN