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General NPI Number Information
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NPI Number | 1467714311
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Entity Type | Organization
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Legal Business Name | EYE CARE ASSOCIATES OF SAN DIEGO MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 06/15/2012
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Last Update Date | 06/15/2012
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Provider Practice Location Address
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Address Line | 4455 MORENA BLVD SUITE 203
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City | SAN DIEGO
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State | CA
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Zip | 92117-4358
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Country | US
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Telephone | 858-274-6828
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Fax | 858-274-6861
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Provider Business Mailing Address
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Address Line | 4455 MORENA BLVD. SUITE 203
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City | SAN DIEGO
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State | CA
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Zip | 92117-4358
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Country | US
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Telephone | 858-274-6828
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Fax | 858-274-6861
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. ANDY LOCK
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Credential |
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Telephone | 858-274-6828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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