Healthcare Provider Details

I. General information

NPI: 1578733424
Provider Name (Legal Business Name): ALAMITOS EYE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10900 LOS ALAMITOS BLVD STE. 102
LOS ALAMITOS CA
90720-2354
US

IV. Provider business mailing address

10900 LOS ALAMITOS BLVD STE. 102
LOS ALAMITOS CA
90720-2354
US

V. Phone/Fax

Practice location:
  • Phone: 562-430-6161
  • Fax: 562-598-3041
Mailing address:
  • Phone: 562-430-6161
  • Fax: 562-598-3041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP10548
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOP10548
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOP10548
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberOP10548
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License NumberOP10548
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License NumberOP10548
License Number StateCA

VIII. Authorized Official

Name: DR. AVANI PATEL
Title or Position: OWNER
Credential: O.D., F.A.A.O.
Phone: 562-430-6161