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General NPI Number Information
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NPI Number | 1780774596
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Entity Type | Organization
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Legal Business Name | THE VISION CENTER AN OPTOMETRIC PRACTICE INCORPORATED
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 04/29/2020
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Provider Practice Location Address
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Address Line | 26506 BOUQUET CANYON RD
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City | SAUGUS
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State | CA
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Zip | 91350-2353
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Country | US
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Telephone | 661-297-2020
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Fax | 661-297-3380
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Provider Business Mailing Address
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Address Line | 26506 BOUQUET CANYON RD
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City | SAUGUS
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State | CA
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Zip | 91350-2353
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Country | US
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Telephone | 661-297-2020
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Fax | 661-297-3380
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Authorized Official
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Title or Position | OPTOMETRIST, OWNER, PRESIDENT
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Name | DR. LARA MIEKO UMEMOTO
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Credential | OD
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Telephone | 661-297-2020
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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 | 4873T
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License Number State | CA
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