| |
5565 Grossmont Center Dr Ste 551, La Mesa, CA 91942-3078 | |
(619) 465-2020 | |
(619) 698-1189 |
Full Name | |
---|---|
Type | Facility |
Speciality | Ophthalmology |
Location | 5565 Grossmont Center Dr Ste 551, La Mesa, California |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1053584474 | NPI | - | NPPES |
1114205432 | Medicaid | CA |
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: (888) 884-3805 | 5565 Grossmont Center Dr Ste 551, La Mesa, CA 91942-3078 Ph: (619) 465-2020 |