Healthcare Provider Details

I. General information

NPI: 1013732486
Provider Name (Legal Business Name): VISIONARY RETAIL MANAGEMENT CA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 CANYON SPRINGS PKWY STE 103
RIVERSIDE CA
92507-0942
US

IV. Provider business mailing address

19100 RIDGEWOOD PKWY BLDG. 1 7TH FLOOR 7TH FLOOR
SAN ANTONIO TX
78259
US

V. Phone/Fax

Practice location:
  • Phone: 951-583-1820
  • Fax: 951-618-7116
Mailing address:
  • Phone: 800-340-0129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DOLSIE MCDONALD
Title or Position: MANAGER
Credential:
Phone: 726-444-4078