Healthcare Provider Details

I. General information

NPI: 1346858537
Provider Name (Legal Business Name): EYECARE SPECIALISTS MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73950 ALESSANDRO DR STE 5
PALM DESERT CA
92260-3637
US

IV. Provider business mailing address

1595 E 17TH ST
SANTA ANA CA
92705-8506
US

V. Phone/Fax

Practice location:
  • Phone: 760-568-3334
  • Fax: 760-568-3335
Mailing address:
  • Phone: 714-399-0678
  • Fax: 714-276-6489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: FELISA MARISOL GALINDO
Title or Position: CREDENTIALING SUPERVISOR
Credential:
Phone: 626-305-9100