Healthcare Provider Details

I. General information

NPI: 1396631388
Provider Name (Legal Business Name): VISION NEUROPSYCHOLOGY & PSYCHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10061 TALBERT AVE # 234
FOUNTAIN VALLEY CA
92708-5159
US

IV. Provider business mailing address

6285 E SPRING ST # 598
LONG BEACH CA
90808-4020
US

V. Phone/Fax

Practice location:
  • Phone: 949-526-9504
  • Fax:
Mailing address:
  • Phone: 205-908-4125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY OBRIEN
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 205-908-4125