Healthcare Provider Details

I. General information

NPI: 1114989803
Provider Name (Legal Business Name): FOGG REMINGTON EYECARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 SHAW AVE SUITE 104
CLOVIS CA
93611-4069
US

IV. Provider business mailing address

1360 E HERNDON AVE SUITE 401
FRESNO CA
93720-3326
US

V. Phone/Fax

Practice location:
  • Phone: 559-298-3600
  • Fax: 559-298-6497
Mailing address:
  • Phone: 559-449-5010
  • Fax: 559-449-5014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. PAULA PENDLEY
Title or Position: CREDENTIALING
Credential:
Phone: 559-449-5011