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General NPI Number Information
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NPI Number | 1629226063
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Entity Type | Organization
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Legal Business Name | VISIONS OPTOMETRY
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Dates
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Enumeration Date | 08/27/2008
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Last Update Date | 08/27/2008
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Provider Practice Location Address
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Address Line | 24351 AVENIDA DE LA CARLOTA SUITE N-3
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-3656
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Country | US
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Telephone | 949-768-4601
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Fax | 949-768-7582
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Provider Business Mailing Address
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Address Line | 24351 AVENIDA DE LA CARLOTA SUITE N-3
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-3656
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Country | US
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Telephone | 949-768-4601
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Fax | 949-768-7582
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Authorized Official
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Title or Position | OWNER
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Name | DR. SCOTT TYLER ANDERSON
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Credential | O.D.
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Telephone | 949-768-4601
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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 | OPT 10279 TPA
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License Number State | CA
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