Healthcare Provider Details

I. General information

NPI: 1851579502
Provider Name (Legal Business Name): FIRSTSIGHT VISION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 MONTE VISTA AVE STE 17
UPLAND CA
91786-8216
US

IV. Provider business mailing address

31700 GRAPE ST
LAKE ELSINORE CA
92532-9785
US

V. Phone/Fax

Practice location:
  • Phone: 909-920-5008
  • Fax: 888-241-9266
Mailing address:
  • Phone: 951-245-3757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH HEIDELMAN
Title or Position: CFO
Credential:
Phone: 909-920-5008