| |
12828 Harbor Blvd Ste 330, Garden Grove, CA 92840-5834 | |
(714) 534-8100 | |
(714) 534-1345 |
Full Name | |
---|---|
Type | Facility |
Speciality | Ophthalmology |
Location | 12828 Harbor Blvd Ste 330, Garden Grove, California |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1467845545 | NPI | - | NPPES |
1760541569 | Other | CA | GROUP NPI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | A69909 (California) | Secondary |
174400000X | Specialist | A69909 (California) | Secondary |
207W00000X | Ophthalmology | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
---|---|
100 E California Blvd, Pasadena, CA 91105-3205 Ph: (626) 568-8838 | 12828 Harbor Blvd Ste 330, Garden Grove, CA 92840-5834 Ph: (714) 534-8100 |