Provider Demographics
NPI:1942395793
Name:VISION PROFESSIONALS A MEDICAL CORPORATION
Entity type:Organization
Organization Name:VISION PROFESSIONALS A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:TINDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-320-7051
Mailing Address - Street 1:1180 N INDIAN CANYON DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4800
Mailing Address - Country:US
Mailing Address - Phone:760-320-7051
Mailing Address - Fax:760-320-7683
Practice Address - Street 1:1180 N INDIAN CANYON DR
Practice Address - Street 2:SUITE 130
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4800
Practice Address - Country:US
Practice Address - Phone:760-320-7051
Practice Address - Fax:760-320-7683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0870720001Medicare NSC
CAZZZ23754ZMedicare ID - Type Unspecified