Healthcare Provider Details

I. General information

NPI: 1043518475
Provider Name (Legal Business Name): VISIONCARE OF CALIFORNAI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2011
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4171 PIEDMONT AVE 109
OAKLAND CA
94611-5175
US

IV. Provider business mailing address

9625 BLACK MOUNTAIN RD
SAN DIEGO CA
92126-4564
US

V. Phone/Fax

Practice location:
  • Phone: 510-655-5622
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NICHOLAS SHASHATI
Title or Position: PRESIDENT
Credential:
Phone: 800-454-4647