Healthcare Provider Details

I. General information

NPI: 1225467038
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA EYE CONSULTANTS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2013
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 N TUSTIN ST STE 150
ORANGE CA
92865-1752
US

IV. Provider business mailing address

3111 N TUSTIN ST STE 150
ORANGE CA
92865-1752
US

V. Phone/Fax

Practice location:
  • Phone: 714-771-2020
  • Fax: 714-771-1900
Mailing address:
  • Phone: 714-771-2020
  • Fax: 714-771-1900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberA107904
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID YOMTOOB
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 952-484-8517