Provider Demographics
NPI:1891196341
Name:NUT TREE OPTOMETRIC CORPORATION
Entity type:Organization
Organization Name:NUT TREE OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KABIR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:916-903-6876
Mailing Address - Street 1:1633 E MONTE VISTA AVE
Mailing Address - Street 2:101
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-3106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1633 E MONTE VISTA AVE
Practice Address - Street 2:101
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-3106
Practice Address - Country:US
Practice Address - Phone:916-903-6876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT13111TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty