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General NPI Number Information
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NPI Number | 1093529158
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Entity Type | Organization
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Legal Business Name | PACIFIC OPTOMETRIC GROUP
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Dates
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Enumeration Date | 02/06/2025
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 4255 CAMPUS DR STE A110
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City | IRVINE
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State | CA
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Zip | 92612-8627
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Country | US
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Telephone | 949-854-7122
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 BRISTOL ST N STE 29
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-8917
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Country | US
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Telephone | 949-476-2870
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Fax | 949-476-3087
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Authorized Official
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Title or Position | PRESIDENT
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Name | HAWAA ALI
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Credential | O.D.
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Telephone | 562-276-8080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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