Healthcare Provider Details

I. General information

NPI: 1437789294
Provider Name (Legal Business Name): PACIFIC PARTNERS OPTOMETRIC GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2020
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 E CANYON RIM RD # 101
ANAHEIM CA
92807-4317
US

IV. Provider business mailing address

6200 E CANYON RIM RD STE 101
ANAHEIM CA
92807-4317
US

V. Phone/Fax

Practice location:
  • Phone: 714-992-8020
  • Fax:
Mailing address:
  • Phone: 714-448-7166
  • Fax: 714-992-8020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: FAVIOLA LOPEZ
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 714-992-8020