| |
58471 29 Palms Hwy, # 203, Yucca Valley, CA 92284-5818 | |
(760) 853-3005 | |
(760) 853-3012 |
Full Name | |
---|---|
Type | Facility |
Speciality | Specialist |
Location | 58471 29 Palms Hwy, Yucca Valley, California |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1316482862 | NPI | - | NPPES |
1114205432 | Medicaid | CA | |
FQ161B | Other | CA | MCR(N) |
FQ161A | Other | CA | MCR(S) |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
174400000X | Specialist | (California) | Primary |
207W00000X | Ophthalmology | (California) | Secondary |
Mailing Address | Practice Location Address |
---|---|
100 E California Blvd, Pasadena, CA 91105-3205 Ph: (626) 568-8838 | 58471 29 Palms Hwy, # 203, Yucca Valley, CA 92284-5818 Ph: (760) 853-3005 |