MEDICARE: T-VISION OPTOMETRY 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	261Q00000X	Clinic/Center	33781TLG	CA

General Provider Information

NPI Number	:	1932607371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	T-VISION OPTOMETRY INC.

Provider Business Mailing Address
First Line	:	15555 E 14TH ST STE 400
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94578-1978
Country	:	US
Telephone Number	:	510-278-8903
Fax Number	:	510-278-8859

Provider Business Practice Location Address
First Line	:	15555 E 14TH ST STE 400
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94578-1978
Country	:	US
Telephone Number	:	510-278-8903
Fax Number	:	510-278-8859

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THY DINH
Credential	:
Telephone Number	:	414-614-6500

Provider Enumeration Date	:	01/31/2018
Last Update Date	:	01/31/2018

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