Healthcare Provider Details

I. General information

NPI: 1891079356
Provider Name (Legal Business Name): VISIONCARE OF CALIFORNIA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2011
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E 3RD AVE
SAN MATEO CA
94401-4012
US

IV. Provider business mailing address

115 E 3RD AVE
SAN MATEO CA
94401-4012
US

V. Phone/Fax

Practice location:
  • Phone: 650-347-1500
  • Fax: 650-347-1023
Mailing address:
  • Phone: 650-347-1500
  • Fax: 650-347-1023

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