Provider Demographics
NPI:1063530210
Name:PROFLUENT SYSTEMS INC
Entity type:Organization
Organization Name:PROFLUENT SYSTEMS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DISPENSING OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:VONARX
Authorized Official - Suffix:
Authorized Official - Credentials:RDO
Authorized Official - Phone:925-757-2992
Mailing Address - Street 1:5887 LONE TREE WAY STE M
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8625
Mailing Address - Country:US
Mailing Address - Phone:925-757-2992
Mailing Address - Fax:925-757-2922
Practice Address - Street 1:5887 LONE TREE WAY STE M
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8625
Practice Address - Country:US
Practice Address - Phone:925-757-2992
Practice Address - Fax:925-757-2922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty