MEDICARE: FOGG REMINGTON EYECARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255393955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOGG REMINGTON EYECARE, INC.

Provider Business Mailing Address
First Line	:	1360 E HERNDON AVE
Second Line	:	SUITE 401
City	:	FRESNO
State	:	CA
Zip	:	93720-3326
Country	:	US
Telephone Number	:	559-449-5010
Fax Number	:	559-449-5014

Provider Business Practice Location Address
First Line	:	2401 W CLEVELAND AVE
Second Line	:
City	:	MADERA
State	:	CA
Zip	:	93637-3608
Country	:	US
Telephone Number	:	559-661-7545
Fax Number	:	559-661-7314

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	MS. PAULA PENDLEY
Credential	:
Telephone Number	:	559-449-5011

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	04/05/2022

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