Provider Demographics
NPI:1770937484
Name:FORESIGHT EYECARE OPTOMETRY
Entity type:Organization
Organization Name:FORESIGHT EYECARE OPTOMETRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:MICHELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:925-672-4100
Mailing Address - Street 1:5442 YGNACIO VALLEY RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-3800
Mailing Address - Country:US
Mailing Address - Phone:925-672-4100
Mailing Address - Fax:925-672-4195
Practice Address - Street 1:5442 YGNACIO VALLEY RD
Practice Address - Street 2:SUITE 180
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-3800
Practice Address - Country:US
Practice Address - Phone:925-672-4100
Practice Address - Fax:925-672-4195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13574TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty