Basic Information
| Provider Information | |||||||||
| NPI: | 1720269160 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FIRSTSIGTH VISION SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1202 MONTE VISTA AVE STE 17 | ||||||||
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| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917868216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099205008 | ||||||||
| FaxNumber: | 8882419266 | ||||||||
| Practice Location | |||||||||
| Address1: | 7147 GREENBACK LN | ||||||||
| Address2: | |||||||||
| City: | CITRUS HEIGHTS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956215526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167233697 | ||||||||
| FaxNumber: | 9167233698 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2007 | ||||||||
| LastUpdateDate: | 11/14/2007 | ||||||||
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| AuthorizedOfficialLastName: | HEIDELMAN | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9099205008 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FIRSTSIGTH VISION SERVICES, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.