Healthcare Provider Details

I. General information

NPI: 1104533108
Provider Name (Legal Business Name): OPTOMETRIC CARE OF NEVADA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 KINGSBURY GRADE STE 103
STATELINE NV
89449-9804
US

IV. Provider business mailing address

3333 QUALITY DR
RANCHO CORDOVA CA
95670-7985
US

V. Phone/Fax

Practice location:
  • Phone: 775-588-3500
  • Fax:
Mailing address:
  • Phone: 704-712-0564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRITTANY HARRISON
Title or Position: DIRECTOR
Credential:
Phone: 916-851-6611