Provider Demographics
NPI:1215259338
Name:EYE CENTER OPTOMETRIC
Entity type:Organization
Organization Name:EYE CENTER OPTOMETRIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-726-1818
Mailing Address - Street 1:5959 GREENBACK LN
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621-4700
Mailing Address - Country:US
Mailing Address - Phone:916-726-1818
Mailing Address - Fax:916-726-1822
Practice Address - Street 1:5959 GREENBACK LN
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-4700
Practice Address - Country:US
Practice Address - Phone:916-726-1818
Practice Address - Fax:916-726-1822
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE CENTER OPTOMETRIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty