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	933342	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	933342	OTHER	CA	DMHC PLAN NUMBER

General Provider Information

NPI Number	:	1750508974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRSTSIGHT VISION SERVICES, INC.

Provider Business Mailing Address
First Line	:	1202 MONTE VISTA AVE
Second Line	:	SUITE 17
City	:	UPLAND
State	:	CA
Zip	:	91786-8208
Country	:	US
Telephone Number	:	909-920-5008
Fax Number	:	909-932-0062

Provider Business Practice Location Address
First Line	:	1202 MONTE VISTA AVE
Second Line	:	SUITE 17
City	:	UPLAND
State	:	CA
Zip	:	91786-8208
Country	:	US
Telephone Number	:	909-920-5008
Fax Number	:	909-932-0062

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	MR. ROBERT K PATTON
Credential	:
Telephone Number	:	909-920-5008

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	08/22/2020

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