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General NPI Number Information
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NPI Number | 1750508974
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Entity Type | Organization
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Legal Business Name | FIRSTSIGHT VISION SERVICES, INC.
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1202 MONTE VISTA AVE SUITE 17
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City | UPLAND
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State | CA
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Zip | 91786-8208
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Country | US
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Telephone | 909-920-5008
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Fax | 909-932-0062
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Provider Business Mailing Address
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Address Line | 1202 MONTE VISTA AVE SUITE 17
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City | UPLAND
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State | CA
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Zip | 91786-8208
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Country | US
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Telephone | 909-920-5008
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Fax | 909-932-0062
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | MR. ROBERT K PATTON
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Credential |
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Telephone | 909-920-5008
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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 | 933342
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License Number State | CA
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