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General NPI Number Information
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NPI Number | 1013732486
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Entity Type | Organization
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Legal Business Name | VISIONARY RETAIL MANAGEMENT CA, INC
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Dates
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Enumeration Date | 11/20/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 2711 CANYON SPRINGS PKWY STE 103
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City | RIVERSIDE
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State | CA
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Zip | 92507-0942
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Country | US
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Telephone | 951-583-1820
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Fax | 951-618-7116
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Provider Business Mailing Address
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Address Line | 19100 RIDGEWOOD PKWY BLDG. 1 7TH FLOOR 7TH FLOOR
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City | SAN ANTONIO
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State | TX
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Zip | 78259
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Country | US
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Telephone | 800-340-0129
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DOLSIE MCDONALD
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Credential |
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Telephone | 726-444-4078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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