Healthcare Provider Details

I. General information

NPI: 1154008027
Provider Name (Legal Business Name): ISLAND EYE SPECIALISTS, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 YNEZ PL STE A
CORONADO CA
92118-3909
US

IV. Provider business mailing address

671 B AVE
CORONADO CA
92118-2225
US

V. Phone/Fax

Practice location:
  • Phone: 760-575-4541
  • Fax: 888-635-8108
Mailing address:
  • Phone: 318-237-5531
  • Fax: 888-635-8108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS AVALLONE
Title or Position: OWNER
Credential: MD
Phone: 318-237-5531