Healthcare Provider Details

I. General information

NPI: 1437181930
Provider Name (Legal Business Name): EYECARE SPECIALISTS MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

947 S. ANAHEIM BLVD SUITE 120
ANAHEIM CA
92805-5590
US

IV. Provider business mailing address

888 S. DISNEYLAND DRIVE SUITE 100
ANAHEIM CA
92802-1828
US

V. Phone/Fax

Practice location:
  • Phone: 714-821-4666
  • Fax: 714-533-6800
Mailing address:
  • Phone: 714-399-0678
  • Fax: 714-276-6489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: FELISA MARISOL GALINDO
Title or Position: CREDENTIALING SUPERVISOR
Credential:
Phone: 626-305-9100