MEDICARE: YUMA VISION CENTER, 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	663	AZ
2	152W00000X	Optometrist	786	AZ

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

General Provider Information

NPI Number	:	1790972388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YUMA VISION CENTER, INC

Provider Business Mailing Address
First Line	:	2750 S PACIFIC AVE STE D
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85365-3547
Country	:	US
Telephone Number	:	928-782-7557
Fax Number	:	928-783-8445

Provider Business Practice Location Address
First Line	:	2750 S PACIFIC AVE STE D
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85365-3547
Country	:	US
Telephone Number	:	928-782-7557
Fax Number	:	928-783-8445

Authorized Official
Title or Position	:	DOCTOR OF OPTOMETRY
Name	:	DR. THOMAS FRANCES DETERMAN
Credential	:	OD
Telephone Number	:	928-782-7557

Provider Enumeration Date	:	09/27/2007
Last Update Date	:	07/26/2021

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Directions to “YUMA VISION CENTER, INC ” Practice Location

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