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General NPI Number Information
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NPI Number | 1942919154
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Entity Type | Organization
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Legal Business Name | VISIONARY OPTOMETRIC INC
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Dates
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Enumeration Date | 11/16/2022
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Last Update Date | 11/16/2022
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Provider Practice Location Address
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Address Line | 7900 ZENITH DR
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City | CITRUS HEIGHTS
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State | CA
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Zip | 95621-1075
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Country | US
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Telephone | 916-725-2020
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Fax | 916-725-1750
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Provider Business Mailing Address
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Address Line | 7900 ZENITH DR
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City | CITRUS HEIGHTS
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State | CA
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Zip | 95621-1075
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Country | US
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Telephone | 916-725-2020
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Fax | 916-725-1750
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. REBECCA D KENNEDY
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Credential | OD
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Telephone | 916-725-2020
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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 |
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License Number State |
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