Provider Demographics
NPI:1023283413
Name:VISION CARE CENTER A MEDICAL GROUP INC
Entity type:Organization
Organization Name:VISION CARE CENTER A MEDICAL GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MOORS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-486-2000
Mailing Address - Street 1:7075 N SHARON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3329
Mailing Address - Country:US
Mailing Address - Phone:559-486-2000
Mailing Address - Fax:
Practice Address - Street 1:7075 N SHARON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3329
Practice Address - Country:US
Practice Address - Phone:559-486-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD001070Medicaid