Healthcare Provider Details

I. General information

NPI: 1376871608
Provider Name (Legal Business Name): VISION FX OPTOMETRIC SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 07/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2465 DISCOVERY BAY BLVD STE 201
DISCOVERY BAY CA
94505-1009
US

IV. Provider business mailing address

2465 DISCOVERY BAY BLVD STE 201
DISCOVERY BAY CA
94505-1009
US

V. Phone/Fax

Practice location:
  • Phone: 925-626-7070
  • Fax: 925-626-7061
Mailing address:
  • Phone: 925-626-7070
  • Fax: 925-626-7061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13393
License Number StateCA

VIII. Authorized Official

Name: DR. JEFFREY RICKS
Title or Position: COO
Credential: O.D.
Phone: 510-449-7669