Healthcare Provider Details

I. General information

NPI: 1538437835
Provider Name (Legal Business Name): CALIFORNIA EYE PROSTHETICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 C ST SUITE 502
SAN DIEGO CA
92101-5318
US

IV. Provider business mailing address

635 C ST SUITE 502
SAN DIEGO CA
92101-5318
US

V. Phone/Fax

Practice location:
  • Phone: 619-235-8950
  • Fax:
Mailing address:
  • Phone: 619-235-8950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State

VIII. Authorized Official

Name: DANIEL THOMAS ACOSTA
Title or Position: OCULARIST
Credential: BCO
Phone: 619-235-8950