Healthcare Provider Details

I. General information

NPI: 1285658872
Provider Name (Legal Business Name): VACAVILLE OPTOMETRIC VISION CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 MERCHANT ST
VACAVILLE CA
95688-4511
US

IV. Provider business mailing address

513 MERCHANT ST
VACAVILLE CA
95688-4511
US

V. Phone/Fax

Practice location:
  • Phone: 707-448-3451
  • Fax: 707-448-1304
Mailing address:
  • Phone: 707-448-3451
  • Fax: 707-448-1304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JANET MARIE ENGLERT
Title or Position: MANAGER
Credential:
Phone: 707-448-3451