Organization
MOUNTAIN VISTA OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA A THORMAHLEN OPTICAN (PRESIDENT)
(951) 692-1323
Entity
Organization
Contact information
Practice address
10440 MAGNOLIA AVE, RIVERSIDE, CA 92505-1812
(951) 692-1323
(866) 258-0370
Mailing address
10440 MAGNOLIA AVE, RIVERSIDE, CA 92505-1812
(951) 692-1323
(866) 258-0370
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
D6924
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DX006924F
—
CA
Enumeration date
03/17/2007
Last updated
09/07/2023
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