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NPI Code Detail

MEDICARE: FIRSTSIGHT VISION SERVICES, INC.

MEDICARE: FIRSTSIGHT VISION SERVICES, 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
1152W00000XOptometrist

General Provider Information

NPI Number : 1376724740
Entity Type Code : Organization
Provider Name (Legal Business Name) : FIRSTSIGHT VISION SERVICES, INC.
Provider Business Mailing Address
First Line : 1202 MONTE VISTA AVE STE 17
Second Line :
City : UPLAND
State : CA
Zip : 91786-8216
Country : US
Telephone Number : 909-920-5008
Fax Number : 888-241-9266
Provider Business Practice Location Address
First Line : 4840 SHAWLINE ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92111-1400
Country : US
Telephone Number : 858-560-5742
Fax Number : 858-569-6596
Authorized Official
Title or Position : CFO
Name : MR. JOSEPH HEIDELMAN
Credential :
Telephone Number : 909-920-5008
Provider Enumeration Date : 11/14/2007
Last Update Date : 11/14/2007

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Directions to “FIRSTSIGHT VISION SERVICES, INC. ” Practice Location

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