Provider Demographics
NPI:1982736252
Name:TAHOE SIERRA EYE & OPTICAL, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:TAHOE SIERRA EYE & OPTICAL, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:KURLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-582-3666
Mailing Address - Street 1:10956 DONNER PASS RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-4861
Mailing Address - Country:US
Mailing Address - Phone:530-582-3666
Mailing Address - Fax:
Practice Address - Street 1:10956 DONNER PASS RD
Practice Address - Street 2:SUITE 120
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4861
Practice Address - Country:US
Practice Address - Phone:530-582-3666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51920174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH26101Medicare UPIN
CAZZZ03568ZMedicare PIN
CA5431070001Medicare NSC