Healthcare Provider Details

I. General information

NPI: 1891468849
Provider Name (Legal Business Name): THIRD OPTOMETRIC CARE OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7960 ORANGETHORPE AVE
BUENA PARK CA
90621-3437
US

IV. Provider business mailing address

3333 QUALITY DR
RANCHO CORDOVA CA
95670-7985
US

V. Phone/Fax

Practice location:
  • Phone: 714-521-3002
  • Fax:
Mailing address:
  • Phone: 916-407-7156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: WINNIE SMITH
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 614-784-5331