Healthcare Provider Details

I. General information

NPI: 1477264901
Provider Name (Legal Business Name): ELITE EYECARE MEDICAL GROUP A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 HARBOR ST
MORRO BAY CA
93442-1904
US

IV. Provider business mailing address

910 E STOWELL RD
SANTA MARIA CA
93454-7001
US

V. Phone/Fax

Practice location:
  • Phone: 805-772-1269
  • Fax:
Mailing address:
  • Phone: 805-925-2637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHAHRIAR RAMI ZARNEGAR
Title or Position: OWNER
Credential:
Phone: 805-925-2637