MEDICARE: FOURTH OPTOMETRIC CARE OF CALIFORNIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1568198281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOURTH OPTOMETRIC CARE OF CALIFORNIA

Provider Business Mailing Address
First Line	:	3333 QUALITY DR
Second Line	:
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95670-7985
Country	:	US
Telephone Number	:	704-712-0564
Fax Number	:

Provider Business Practice Location Address
First Line	:	20929 VENTURA BLVD STE 23
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-3352
Country	:	US
Telephone Number	:	951-684-7822
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	BRITTANY HARRISON
Credential	:
Telephone Number	:	512-316-4603

Provider Enumeration Date	:	07/26/2022
Last Update Date	:	12/03/2024

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Directions to “FOURTH OPTOMETRIC CARE OF CALIFORNIA ” Practice Location

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