Provider Demographics
NPI:1881721918
Name:VISION PROFESSIONALS A MEDICAL CORPORATION
Entity type:Organization
Organization Name:VISION PROFESSIONALS A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:TINDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-320-7051
Mailing Address - Street 1:57019 YUCCA TRL
Mailing Address - Street 2:STE D
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-7909
Mailing Address - Country:US
Mailing Address - Phone:760-369-7350
Mailing Address - Fax:760-369-7352
Practice Address - Street 1:57019 YUCCA TRL
Practice Address - Street 2:STE D
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-7909
Practice Address - Country:US
Practice Address - Phone:760-369-7350
Practice Address - Fax:760-369-7352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ21537ZMedicare ID - Type Unspecified
CA0870720002Medicare NSC