Healthcare Provider Details

I. General information

NPI: 1689248874
Provider Name (Legal Business Name): FOURTH OPTOMETRIC CARE OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 CASTRO ST
MOUNTAIN VIEW CA
94041-2086
US

IV. Provider business mailing address

3333 QUALITY DR
RANCHO CORDOVA CA
95670-7985
US

V. Phone/Fax

Practice location:
  • Phone: 650-967-6649
  • Fax: 650-967-0237
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: BRITTANY HARRISON
Title or Position: DIRECTOR
Credential:
Phone: 512-316-4603