Healthcare Provider Details

I. General information

NPI: 1851856793
Provider Name (Legal Business Name): TRILOGY EYE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 02/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73180 EL PASEO
PALM DESERT CA
92260-4218
US

IV. Provider business mailing address

100 E CALIFORNIA BLVD
PASADENA CA
91105-3205
US

V. Phone/Fax

Practice location:
  • Phone: 760-490-0068
  • Fax:
Mailing address:
  • Phone: 626-568-8838
  • 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: SHERI LEE ALLEY
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 951-249-9225