Healthcare Provider Details

I. General information

NPI: 1134365679
Provider Name (Legal Business Name): EYE AND VISION CENTRAL CALIFORNIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 W CLEVELAND AVE STE 103
MADERA CA
93637-8753
US

IV. Provider business mailing address

2325 W CLEVELAND AVE STE 103
MADERA CA
93637-8753
US

V. Phone/Fax

Practice location:
  • Phone: 559-674-4700
  • Fax: 559-674-3900
Mailing address:
  • Phone: 559-674-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA80829
License Number StateCA

VIII. Authorized Official

Name: NING LIN
Title or Position: PRESDENT
Credential: M.D.
Phone: 559-674-4700