Provider Demographics
NPI:1336446319
Name:PLACER OPTOMETRY, INC.
Entity type:Organization
Organization Name:PLACER OPTOMETRY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN WINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-925-3448
Mailing Address - Street 1:9260 SIERRA COLLEGE BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-5932
Mailing Address - Country:US
Mailing Address - Phone:916-791-2526
Mailing Address - Fax:916-791-2561
Practice Address - Street 1:9260 SIERRA COLLEGE BLVD STE 500
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-5932
Practice Address - Country:US
Practice Address - Phone:916-791-2526
Practice Address - Fax:916-791-2561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty