MEDICARE: ULTIMATE VISION CARE

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	261QS0132X	Ophthalmologic Surgery Clinic/Center	8032TG	TX

General Provider Information

NPI Number	:	1568804771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTIMATE VISION CARE

Provider Business Mailing Address
First Line	:	5860 N TARRANT PKWY
Second Line	:	108
City	:	FORT WORTH
State	:	TX
Zip	:	76244-7201
Country	:	US
Telephone Number	:	817-656-0440
Fax Number	:

Provider Business Practice Location Address
First Line	:	5860 N TARRANT PKWY
Second Line	:	108
City	:	FORT WORTH
State	:	TX
Zip	:	76244-7201
Country	:	US
Telephone Number	:	817-656-0440
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. YURY RONIN
Credential	:	O.D.
Telephone Number	:	682-554-2079

Provider Enumeration Date	:	07/29/2013
Last Update Date	:	07/29/2013

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Directions to “ULTIMATE VISION CARE ” Practice Location

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