Healthcare Provider Details

I. General information

NPI: 1427258755
Provider Name (Legal Business Name): ERWIN M OMENS MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 E OHIO AVE
ESCONDIDO CA
92025-3421
US

IV. Provider business mailing address

810 E OHIO AVE
ESCONDIDO CA
92025-3421
US

V. Phone/Fax

Practice location:
  • Phone: 760-745-9500
  • Fax: 760-746-3991
Mailing address:
  • Phone: 760-745-9500
  • Fax: 760-746-3991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG38629
License Number StateCA

VIII. Authorized Official

Name: MR. ERWIN M OMENS
Title or Position: OWNER
Credential: M.D.
Phone: 760-745-9500