Provider Demographics
NPI: | 1235319971 |
---|---|
Name: | FIRSTSIGHT VISION SERVICES, INC. |
Entity type: | Organization |
Organization Name: | FIRSTSIGHT VISION SERVICES, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | JOSEPH |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HEIDELMAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 909-920-5005 |
Mailing Address - Street 1: | 1202 MONTE VISTA AVE STE 17 |
Mailing Address - Street 2: | |
Mailing Address - City: | UPLAND |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 91786-8216 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 909-920-5008 |
Mailing Address - Fax: | 888-241-9266 |
Practice Address - Street 1: | 2700 LAS POSITAS RD |
Practice Address - Street 2: | |
Practice Address - City: | LIVERMORE |
Practice Address - State: | CA |
Practice Address - Zip Code: | 94551-9619 |
Practice Address - Country: | US |
Practice Address - Phone: | 925-606-8442 |
Practice Address - Fax: | 925-960-0659 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | FIRSTSIGHT VISION SERVICES, INC. |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2007-11-09 |
Last Update Date: | 2007-11-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Single Specialty |