Provider Demographics
NPI:1225040413
Name:DAVID W. MURIS SACRAMENTO VISIONCARE OPTOMETRIC CENTER
Entity type:Organization
Organization Name:DAVID W. MURIS SACRAMENTO VISIONCARE OPTOMETRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MURIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:916-929-9162
Mailing Address - Street 1:1111 HOWE AVE
Mailing Address - Street 2:SUITE 235
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-8541
Mailing Address - Country:US
Mailing Address - Phone:916-929-9162
Mailing Address - Fax:916-929-8837
Practice Address - Street 1:1111 HOWE AVE
Practice Address - Street 2:SUITE 235
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-8541
Practice Address - Country:US
Practice Address - Phone:916-929-9162
Practice Address - Fax:916-929-8837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP 2719152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD003150Medicaid
CAT09862Medicare UPIN
CA6152040001Medicare NSC
CAGSD003150Medicaid