Provider Demographics
NPI:1912960253
Name:FOGG REMINGTON EYECARE, INC.
Entity Type:Organization
Organization Name:FOGG REMINGTON EYECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-449-5011
Mailing Address - Street 1:1360 E HERNDON AVE
Mailing Address - Street 2:401
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3326
Mailing Address - Country:US
Mailing Address - Phone:559-449-5010
Mailing Address - Fax:559-449-5014
Practice Address - Street 1:3830 N 1ST ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-4301
Practice Address - Country:US
Practice Address - Phone:559-226-3971
Practice Address - Fax:559-241-0368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-08
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1304310003OtherCIGNA MEDICARE DMERC
CAGR0078920Medicaid
CAGR0078920Medicaid