Healthcare Provider Details

I. General information

NPI: 1548583255
Provider Name (Legal Business Name): GOLD COAST VISION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 W 5TH ST
OXNARD CA
93030-7049
US

IV. Provider business mailing address

461 W 5TH ST
OXNARD CA
93030-7049
US

V. Phone/Fax

Practice location:
  • Phone: 805-816-5474
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License NumberA74626
License Number StateCA

VIII. Authorized Official

Name: DR. FRANZ MICHEL
Title or Position: DIRECTOR
Credential: MD
Phone: 805-816-5474