Healthcare Provider Details

I. General information

NPI: 1477519205
Provider Name (Legal Business Name): ERWIN M OMENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 EAST OHIO AVENUE
ESCONDIDO CA
92025-3421
US

IV. Provider business mailing address

810 EAST OHIO AVENUE
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:
Title or Position:
Credential:
Phone: