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General NPI Number Information
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NPI Number | 1740242445
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Entity Type | Organization
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Legal Business Name | FOGG REMINGTON EYECARE, INC.
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Dates
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Enumeration Date | 04/06/2006
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Last Update Date | 06/15/2022
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Provider Practice Location Address
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Address Line | 40232 JUNCTION DR
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City | OAKHURST
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State | CA
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Zip | 93644-8719
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Country | US
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Telephone | 559-658-6402
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Fax | 559-658-6476
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Provider Business Mailing Address
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Address Line | 1360 E HERNDON AVE SUITE 401
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City | FRESNO
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State | CA
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Zip | 93720-3326
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Country | US
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Telephone | 559-449-5010
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Fax | 559-449-5014
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Authorized Official
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Title or Position | CREDENTIALING
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Name | MARCI WILLIS
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Credential |
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Telephone | 559-226-3973
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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 |
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License Number State | CA
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