| |
1403 N Tustin Ave Ste 399, Santa Ana, CA 92705-8691 | |
(714) 884-3961 | |
(714) 884-3458 |
Full Name | |
---|---|
Type | Facility |
Speciality | Ophthalmology |
Location | 1403 N Tustin Ave Ste 399, Santa Ana, California |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1124411285 | NPI | - | NPPES |
1760541569 | Other | CA | GROUP NPI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | A69909 (California) | Secondary |
207W00000X | Ophthalmology | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
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100 E California Blvd, Pasadena, CA 91105-3205 Ph: (626) 568-8838 | 1403 N Tustin Ave Ste 399, Santa Ana, CA 92705-8691 Ph: (714) 884-3961 |