Healthcare Provider Details

I. General information

NPI: 1285270900
Provider Name (Legal Business Name): EAST-WEST EYE INSTITUTE A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2019
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 W BADILLO ST
COVINA CA
91723-1834
US

IV. Provider business mailing address

75 ENTERPRISE STE 200
ALISO VIEJO CA
92656-2626
US

V. Phone/Fax

Practice location:
  • Phone: 626-732-2200
  • Fax: 626-732-2900
Mailing address:
  • Phone: 949-688-6205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: NICOLE TURNER
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 949-688-6205