Provider Demographics
NPI:1043475627
Name:NORTH VALLEY EYE CARE
Entity type:Organization
Organization Name:NORTH VALLEY EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULES
Authorized Official - Middle Name:R
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-891-1900
Mailing Address - Street 1:114 MISSION RANCH BLVD
Mailing Address - Street 2:SUITE 50
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-5137
Mailing Address - Country:US
Mailing Address - Phone:530-891-1900
Mailing Address - Fax:530-895-1531
Practice Address - Street 1:114 MISSION RANCH BLVD
Practice Address - Street 2:SUITE 50
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-5137
Practice Address - Country:US
Practice Address - Phone:530-891-1900
Practice Address - Fax:530-895-1531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152W00000X, 207W00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADP9901OtherRAILROAD MEDICARE
CAAU491ZMedicare PIN
CA5735750001Medicare NSC