Healthcare Provider Details

I. General information

NPI: 1265515878
Provider Name (Legal Business Name): EMPIRE EYE AND LASER CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 02/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 EMPIRE DR SUITE 120
BAKERSFIELD CA
93309-0681
US

IV. Provider business mailing address

4101 EMPIRE DR SUITE 120
BAKERSFIELD CA
93309-0681
US

V. Phone/Fax

Practice location:
  • Phone: 661-325-3937
  • Fax: 661-283-3937
Mailing address:
  • Phone: 661-325-3937
  • Fax: 661-283-3937

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
# 3
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberZ18298
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRANDY SPARKS
Title or Position: BILLING MGR
Credential:
Phone: 661-869-2600