NPIMap

Organization Active NPI

Mountain Vista Optical

  • Eyewear Supplier
  • Riverside, CA
National Provider Identifier
1649394545
Registry record updated Sep 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
License
D6924 Issued in CA
Legal business name
MOUNTAIN VISTA OPTICAL
Practice address
10440 Magnolia Ave
Riverside, CA 92505-1812
Phone
(951) 692-1323
Fax
(866) 258-0370
NPI assigned
Mar 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2023

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

Authorized official

Name
Patricia A Thormahlen, OPTICAN
Title
President
Phone
(951) 692-1323

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X D6924 CA Primary

Addresses

Primary practice location

10440 Magnolia Ave
Riverside, CA 92505-1812

Mailing address

10440 Magnolia Ave
Riverside, CA 92505-1812
Phone (951) 692-1323

Other identifiers 1

IdentifierTypeStateIssuer
DX006924FMedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Mountain Vista Optical3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

10440 Magnolia Ave
Riverside, CA 92505
Phone (951) 353-2020

NPI Registry JSON

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

{
    "created_epoch": "1174089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694044800000",
    "number": "1649394545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10440 MAGNOLIA AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925051812",
            "telephone_number": "951-692-1323",
            "fax_number": "866-258-0370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10440 MAGNOLIA AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925051812",
            "telephone_number": "951-692-1323",
            "fax_number": "866-258-0370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN VISTA OPTICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-17",
        "last_updated": "2023-09-07",
        "status": "A",
        "authorized_official_last_name": "THORMAHLEN",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-692-1323",
        "authorized_official_credential": "OPTICAN"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "CA",
            "license": "D6924",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DX006924F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Sep 7, 2023; 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.