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General NPI Number Information
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NPI Number | 1700485562
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Entity Type | Organization
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Legal Business Name | VISION FAIRE OPTOMETRY, INC. A PROFESSIONAL OPTOMETRIC CORPORATION
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Dates
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Enumeration Date | 10/22/2020
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Last Update Date | 10/22/2020
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Provider Practice Location Address
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Address Line | 4213 DALE RD STE A-2
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City | MODESTO
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State | CA
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Zip | 95356-8505
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Country | US
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Telephone | 209-545-3937
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Fax | 209-545-0204
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Provider Business Mailing Address
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Address Line | 4213 DALE RD STE A-2
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City | MODESTO
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State | CA
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Zip | 95356-8505
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Country | US
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Telephone | 209-545-3937
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Fax | 209-545-0204
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NANCY ELAINE SHOJI
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Credential | OD
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Telephone | 209-545-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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