MEDICARE: VISIONS OPTOMETRY

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	OPT 10279 TPA	CA

General Provider Information

NPI Number	:	1629226063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISIONS OPTOMETRY

Provider Business Mailing Address
First Line	:	24351 AVENIDA DE LA CARLOTA
Second Line	:	SUITE N-3
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3656
Country	:	US
Telephone Number	:	949-768-4601
Fax Number	:	949-768-7582

Provider Business Practice Location Address
First Line	:	24351 AVENIDA DE LA CARLOTA
Second Line	:	SUITE N-3
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3656
Country	:	US
Telephone Number	:	949-768-4601
Fax Number	:	949-768-7582

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SCOTT TYLER ANDERSON
Credential	:	O.D.
Telephone Number	:	949-768-4601

Provider Enumeration Date	:	08/27/2008
Last Update Date	:	08/27/2008

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