Provider Demographics
NPI:1780774596
Name:THE VISION CENTER AN OPTOMETRIC PRACTICE INCORPORATED
Entity type:Organization
Organization Name:THE VISION CENTER AN OPTOMETRIC PRACTICE INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST, OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARA
Authorized Official - Middle Name:MIEKO
Authorized Official - Last Name:UMEMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:661-297-2020
Mailing Address - Street 1:26506 BOUQUET CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:CA
Mailing Address - Zip Code:91350-2353
Mailing Address - Country:US
Mailing Address - Phone:661-297-2020
Mailing Address - Fax:661-297-3380
Practice Address - Street 1:26506 BOUQUET CANYON RD
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:CA
Practice Address - Zip Code:91350-2353
Practice Address - Country:US
Practice Address - Phone:661-297-2020
Practice Address - Fax:661-297-3380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4873T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAO571ZOtherMEDICARE PIN
CAGSD004840Medicaid
CASD0109840Medicaid
CA0997280001Medicare NSC