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General NPI Number Information
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NPI Number | 1295320778
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Entity Type | Organization
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Legal Business Name | FIRST OPTOMETRIC CARE OF NORTHERN CALIFORNIA PC
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Dates
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Enumeration Date | 03/05/2021
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Last Update Date | 03/27/2023
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Provider Practice Location Address
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Address Line | 11733 FAIR OAKS BLVD
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City | FAIR OAKS
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State | CA
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Zip | 95628-2816
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Country | US
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Telephone | 916-966-6080
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Fax |
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Provider Business Mailing Address
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Address Line | 3333 QUALITY DR
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670-7985
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Country | US
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Telephone | 916-851-4073
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | CHRISTOPHER CRUMP
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Credential |
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Telephone | 571-866-1887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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