Healthcare Provider Details

I. General information

NPI: 1689158453
Provider Name (Legal Business Name): VAIL RANCH VISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40764 WINCHESTER RD STE 580
TEMECULA CA
92591-6502
US

IV. Provider business mailing address

31805 TEMECULA PKWY STE D-5
TEMECULA CA
92592-8200
US

V. Phone/Fax

Practice location:
  • Phone: 951-541-3427
  • Fax:
Mailing address:
  • Phone: 951-383-4104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICK W UTNEHMER
Title or Position: OWNER
Credential:
Phone: 951-541-7157