| |
1620 Alpine Blvd Ste 117, Alpine, CA 91901-1103 | |
(619) 445-2687 | |
(619) 445-0801 |
Full Name | |
---|---|
Type | Facility |
Speciality | Ophthalmology |
Location | 1620 Alpine Blvd Ste 117, Alpine, California |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1821507435 | NPI | - | NPPES |
FQ161B | Other | CA | MCR (N) |
1114205432 | Medicaid | CA | |
FQ161A | Other | CA | MCR (S) |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (California) | Secondary |
174400000X | Specialist | (California) | Secondary |
207W00000X | Ophthalmology | (California) | Primary |
Mailing Address | Practice Location Address |
---|---|
100 E California Blvd, Pasadena, CA 91105-3205 Ph: (626) 269-5371 | 1620 Alpine Blvd Ste 117, Alpine, CA 91901-1103 Ph: (619) 445-2687 |