Healthcare Provider Details

I. General information

NPI: 1568494649
Provider Name (Legal Business Name): EYECARE SPECIALISTS MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8028 3RD ST
DOWNEY CA
90241-3602
US

IV. Provider business mailing address

2571 W. LA PALMA AVE.
ANAHEIM CA
92801
US

V. Phone/Fax

Practice location:
  • Phone: 562-622-8700
  • Fax: 562-622-1800
Mailing address:
  • Phone: 714-821-4666
  • Fax: 714-826-2300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberW14969A
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberW14969A
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: FELISA MARISOL GALINDO
Title or Position: CREDENTIALING SUPERVISOR
Credential:
Phone: 626-305-9100