Healthcare Provider Details

I. General information

NPI: 1245352228
Provider Name (Legal Business Name): MONTEREY EYE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 UPPER RAGSDALE DR 200
MONTEREY CA
93940-7831
US

IV. Provider business mailing address

21 UPPER RAGSDALE DR 200
MONTEREY CA
93940-7831
US

V. Phone/Fax

Practice location:
  • Phone: 831-372-1500
  • Fax: 831-655-6493
Mailing address:
  • Phone: 831-372-1500
  • Fax: 831-655-6493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number5651890001
License Number StateCA

VIII. Authorized Official

Name: ROGER HUSTED
Title or Position: OWNER
Credential: M.D.
Phone: 831-372-1500