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General NPI Number Information
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NPI Number | 1366645285
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Entity Type | Organization
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Legal Business Name | ROSEVILLE SITE FOR VISION PRODUCTS, INC.
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1095 ROSEVILLE SQ
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City | ROSEVILLE
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State | CA
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Zip | 95678-2809
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Country | US
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Telephone | 916-782-9985
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Fax | 916-782-9987
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Provider Business Mailing Address
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Address Line | 1095 ROSEVILLE SQ
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City | ROSEVILLE
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State | CA
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Zip | 95678-2809
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Country | US
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Telephone | 916-782-9985
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Fax | 916-782-9987
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Authorized Official
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Title or Position | OWNER OPTICIAN
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Name | MR. LARRY ANTHONY RINKER
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Credential |
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Telephone | 916-782-9985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | D7262
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License Number State | CA
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