Healthcare Provider Details

I. General information

NPI: 1891897740
Provider Name (Legal Business Name): TEMECULA EYE MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41877 ENTERPRISE CIR N STE. 110
TEMECULA CA
92590-5656
US

IV. Provider business mailing address

41877 ENTERPRISE CIR N STE. 110
TEMECULA CA
92590-5656
US

V. Phone/Fax

Practice location:
  • Phone: 951-296-2244
  • Fax: 951-296-3713
Mailing address:
  • Phone: 951-296-2244
  • Fax: 951-296-3713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG28719
License Number StateCA

VIII. Authorized Official

Name: DR. WILLIAM BERWYN SMITH
Title or Position: PRES
Credential: M.D.
Phone: 951-296-2244