Healthcare Provider Details

I. General information

NPI: 1942503933
Provider Name (Legal Business Name): VISION CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2010
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 S HARBOR BLVD STE 104
SANTA ANA CA
92704-6857
US

IV. Provider business mailing address

3301 S HARBOR BLVD STE 104
SANTA ANA CA
92704-6857
US

V. Phone/Fax

Practice location:
  • Phone: 714-979-2021
  • Fax: 714-549-3367
Mailing address:
  • Phone: 714-979-2021
  • Fax: 714-549-3367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number5504
License Number StateCA

VIII. Authorized Official

Name: DR. WILLIAM BERKE
Title or Position: PRESIDENT/OWNER
Credential: O.D.
Phone: 714-979-2021