NPIMap

Organization Active NPI

Vision for Life Optometry, Inc.

Doing business as Woodcrest Vision Center Optometry

  • Optometrist
  • Riverside, CA
National Provider Identifier
1427434984
Registry record updated Aug 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
CA13879T Issued in CA
Legal business name
VISION FOR LIFE OPTOMETRY, INC.
Doing business as
Woodcrest Vision Center Optometry
Practice address
17675 Van Buren Blvd
Suite C
Riverside, CA 92504-6084
Phone
(951) 780-0270
NPI assigned
Aug 7, 2015
Last updated
Aug 7, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Vanessa Shaw McMinn KashakNPI 1639404189
Title
Owner/ President
Phone
(951) 780-0270

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X CA13879T CA Primary

Addresses

Primary practice location

17675 Van Buren Blvd
Suite C
Riverside, CA 92504-6084

Mailing address

17675 Van Buren Blvd
Suite C
Riverside, CA 92504-6084
Phone (951) 780-0270

Other identifiers 1

IdentifierTypeStateIssuer
7362840MedicaidCA

Other names 1

  • Woodcrest Vision Center Optometry Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1438905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438905600000",
    "number": "1427434984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17675 VAN BUREN BLVD",
            "address_2": "SUITE C",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925046084",
            "telephone_number": "951-780-0270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17675 VAN BUREN BLVD",
            "address_2": "SUITE C",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925046084",
            "telephone_number": "951-780-0270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISION FOR LIFE OPTOMETRY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-07",
        "last_updated": "2015-08-07",
        "status": "A",
        "authorized_official_last_name": "KASHAK",
        "authorized_official_first_name": "VANESSA",
        "authorized_official_middle_name": "SHAW MCMINN",
        "authorized_official_title_or_position": "OWNER/ PRESIDENT",
        "authorized_official_telephone_number": "951-780-0270"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "CA13879T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7362840",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Woodcrest Vision Center Optometry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.