Healthcare Provider Details

I. General information

NPI: 1427059336
Provider Name (Legal Business Name): EYE INSTITUTE OF CALIFORNIA MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 DEL MAR AVE
CHULA VISTA CA
91910-3908
US

IV. Provider business mailing address

311 DEL MAR AVE
CHULA VISTA CA
91910-3908
US

V. Phone/Fax

Practice location:
  • Phone: 619-427-3355
  • Fax: 619-427-0955
Mailing address:
  • Phone: 619-427-3355
  • Fax: 619-427-0955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DAVID JOSEPH GOLDMAN
Title or Position: DIRECTOR
Credential: MD
Phone: 619-427-3355