Provider Demographics
NPI:1518733567
Name:STEVEN PREVISICH A PROFESSIONAL OPTOMETRIC CORPORATION
Entity type:Organization
Organization Name:STEVEN PREVISICH A PROFESSIONAL OPTOMETRIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIDGETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-401-2096
Mailing Address - Street 1:2137 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-4106
Mailing Address - Country:US
Mailing Address - Phone:251-401-2096
Mailing Address - Fax:714-999-1439
Practice Address - Street 1:2137 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-4106
Practice Address - Country:US
Practice Address - Phone:251-401-2096
Practice Address - Fax:714-999-1439
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEVEN PREVISICH A PROFESSIONAL OPTOMETRIC CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-30
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty