Provider Demographics
NPI:1861787624
Name:IDEAL FORTUNE CO. INC.
Entity type:Organization
Organization Name:IDEAL FORTUNE CO. INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:GO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-525-9500
Mailing Address - Street 1:1535 LANDESS AVE
Mailing Address - Street 2:SUITE 133
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-8208
Mailing Address - Country:US
Mailing Address - Phone:408-934-9117
Mailing Address - Fax:
Practice Address - Street 1:1535 LANDESS AVE
Practice Address - Street 2:SUITE 133
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-8208
Practice Address - Country:US
Practice Address - Phone:408-934-9117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD7585156FC0800X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Multi-Specialty