| |
14501 Magnolia St, Suite 103, Westminster, CA 92683-1306 | |
(714) 594-7575 | |
(714) 594-7576 |
Full Name | |
---|---|
Type | Facility |
Speciality | Specialist |
Location | 14501 Magnolia St, Westminster, California |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1043665920 | NPI | - | NPPES |
1114205432 | Medicaid | CA | |
FQ161A | Other | CA | MCR(S) |
FQ161B | Other | CA | MCR(N) |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (California) | 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 | 14501 Magnolia St, Suite 103, Westminster, CA 92683-1306 Ph: (714) 594-7575 |