Healthcare Provider Details

I. General information

NPI: 1467599597
Provider Name (Legal Business Name): VISIONCARE OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 BATTERY ST
SAN FRANCISCO CA
94111-4903
US

IV. Provider business mailing address

9625 BLACK MOUNTAIN RD SUITE 311
SAN DIEGO CA
92126-4564
US

V. Phone/Fax

Practice location:
  • Phone: 415-421-2020
  • Fax: 415-421-6072
Mailing address:
  • Phone: 800-454-4647
  • Fax: 858-831-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberDMHC-9330287
License Number StateCA

VIII. Authorized Official

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