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
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1558541821
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	:	909-241-9266

Provider Business Practice Location Address
First Line	:	3600 W MCFADDEN AVE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-1330
Country	:	US
Telephone Number	:	714-531-3068
Fax Number	:	714-531-4361

Authorized Official
Title or Position	:	CFO
Name	:	MR. JOSEPH HEIDELMAN
Credential	:
Telephone Number	:	909-920-5008

Provider Enumeration Date	:	11/05/2007
Last Update Date	:	11/05/2007

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