| |
1640 Newport Blvd Ste 220, Costa Mesa, CA 92627-3786 | |
(949) 876-5046 | |
(949) 573-5394 |
Full Name | |
---|---|
Type | Facility |
Speciality | Ophthalmology |
Location | 1640 Newport Blvd Ste 220, Costa Mesa, California |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1134588932 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | A69909 (California) | Secondary |
207W00000X | Ophthalmology | A69909 (California) | Primary |
Mailing Address | Practice Location Address |
---|---|
100 E California Blvd, Pasadena, CA 91105-3205 Ph: (800) 898-2020 | 1640 Newport Blvd Ste 220, Costa Mesa, CA 92627-3786 Ph: (949) 876-5046 |