Healthcare Provider Details

I. General information

NPI: 1235312687
Provider Name (Legal Business Name): FIRSTSIGHT VISION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 12/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 E ONTARIO AVE
CORONA CA
92881-6604
US

IV. Provider business mailing address

1202 MONTE VISTA AVE STE 17
UPLAND CA
91786-8216
US

V. Phone/Fax

Practice location:
  • Phone: 951-549-8713
  • Fax: 951-549-0592
Mailing address:
  • Phone: 909-920-5008
  • Fax: 888-241-9266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JOSEPH HEIDELMAN
Title or Position: CFO
Credential:
Phone: 909-920-5008