Healthcare Provider Details

I. General information

NPI: 1699059626
Provider Name (Legal Business Name): VISIONCARE OF CALIFORNIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 FILLMORE ST STE 100
SAN FRANCISCO CA
94115-3180
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 415-922-0600
  • Fax: 415-922-1090
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 Number
License Number State

VIII. Authorized Official

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