MEDICARE: CHICO VISION CARE OPTOMETRY GROUP

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	OPT 5613 TPL	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	46196	OTHER	CA	SAFEGUARD
4	CV07521	OTHER	CA	SPECTERA
5	116313	OTHER	CA	EYEMED

General Provider Information

NPI Number	:	1275519571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICO VISION CARE OPTOMETRY GROUP

Provider Business Mailing Address
First Line	:	2109 FOREST AVE
Second Line	:	SUITE 50
City	:	CHICO
State	:	CA
Zip	:	95928-7680
Country	:	US
Telephone Number	:	530-342-9644
Fax Number	:	530-342-7547

Provider Business Practice Location Address
First Line	:	2109 FOREST AVE
Second Line	:	SUITE 50
City	:	CHICO
State	:	CA
Zip	:	95928-7680
Country	:	US
Telephone Number	:	530-342-9644
Fax Number	:	530-342-7547

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. OBBIE PENNINGTON
Credential	:	O.D.
Telephone Number	:	530-342-9644

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	06/05/2020

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Directions to “CHICO VISION CARE OPTOMETRY GROUP ” Practice Location

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