Healthcare Provider Details

I. General information

NPI: 1821666546
Provider Name (Legal Business Name): VISION ACADEMY SF- AN OPTOMETRIC CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 3RD ST STE C
SAN RAFAEL CA
94901-3580
US

IV. Provider business mailing address

361 3RD ST STE C
SAN RAFAEL CA
94901-3580
US

V. Phone/Fax

Practice location:
  • Phone: 415-459-2020
  • Fax: 415-459-2021
Mailing address:
  • Phone: 415-459-2020
  • Fax: 415-459-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State

VIII. Authorized Official

Name: JEREMY SHUMAKER
Title or Position: OWNER
Credential: OD
Phone: 510-928-4986