Healthcare Provider Details

I. General information

NPI: 1801532312
Provider Name (Legal Business Name): ATHENA EYE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2022
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26800 CROWN VALLEY PKWY STE 340
MISSION VIEJO CA
92691-8021
US

IV. Provider business mailing address

15333 CULVER DR STE 340F
IRVINE CA
92604-3078
US

V. Phone/Fax

Practice location:
  • Phone: 949-889-2020
  • Fax: 949-288-5097
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number
License Number State

VIII. Authorized Official

Name: AUDREY TAI
Title or Position: PRESIDENT
Credential: DO
Phone: 949-889-2020