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General NPI Number Information
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NPI Number | 1396924809
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Entity Type | Organization
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Legal Business Name | VISIONARY OPTOMETRY
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Dates
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Enumeration Date | 10/31/2007
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Last Update Date | 04/28/2010
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Provider Practice Location Address
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Address Line | 640 ESCONDIDO AVE SUITE 114
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City | VISTA
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State | CA
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Zip | 92084-6172
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Country | US
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Telephone | 760-630-8200
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Fax | 760-630-8288
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Provider Business Mailing Address
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Address Line | 640 ESCONDIDO AVE SUITE 114
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City | VISTA
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State | CA
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Zip | 92084-6172
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Country | US
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Telephone | 760-630-8200
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Fax | 760-630-8288
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. KEN LAY
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Credential | OD
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Telephone | 760-630-8200
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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 | 10767T
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License Number State | CA
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