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General NPI Number Information
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NPI Number | 1548465222
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Entity Type | Organization
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Legal Business Name | VISION CARE CENTER OF SOUTHEASTERN CA AN OPTOMETRIC CORP.
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 02/11/2015
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Provider Practice Location Address
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Address Line | 260 MAIN ST
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City | BRAWLEY
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State | CA
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Zip | 92227-2351
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Country | US
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Telephone | 760-351-2020
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Fax | 760-344-4552
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Provider Business Mailing Address
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Address Line | PO BOX 1071
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City | BRAWLEY
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State | CA
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Zip | 92227-1071
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Country | US
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Telephone | 760-351-2020
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Fax | 760-344-4552
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. DONALD LEE BARNISKE
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Credential | O.D.
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Telephone | 760-351-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 005636
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 005636
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 005636
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 005636
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 152WX0102X
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Taxonomy Name | Occupational Vision Optometrist
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License Number | 005636
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 005636
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License Number State | CA
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