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General NPI Number Information
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NPI Number | 1336329515
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Entity Type | Organization
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Legal Business Name | FIRSTSIGHT VISION SRVICES, INC.
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Dates
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Enumeration Date | 11/06/2007
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 5180 SONOMA BLVD
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City | VALLEJO
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State | CA
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Zip | 94589-1661
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Country | US
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Telephone | 707-557-4178
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Fax | 707-557-4073
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Provider Business Mailing Address
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Address Line | 1202 MONTE VISTA AVE STE 17
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City | UPLAND
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State | CA
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Zip | 91786-8216
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Country | US
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Telephone | 909-920-5008
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Fax | 888-241-9266
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Authorized Official
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Title or Position | CFO
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Name | MR. JOSEPH HEIDELMAN
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Credential |
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Telephone | 909-920-5008
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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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