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General NPI Number Information
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NPI Number | 1609879436
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Entity Type | Organization
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Legal Business Name | EYE CARE MEDICAL GROUP A PROFESSIONAL CORP
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 06/24/2016
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Provider Practice Location Address
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Address Line | 1665 DOMINICAN WAY STE 122
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City | SANTA CRUZ
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State | CA
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Zip | 95065-1528
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Country | US
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Telephone | 831-476-1298
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Fax |
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Provider Business Mailing Address
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Address Line | 1665 DOMINICAN WAY STE 122
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City | SANTA CRUZ
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State | CA
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Zip | 95065-1528
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Country | US
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Telephone | 831-476-1298
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTEN ALLAMAN
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Credential | MD
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Telephone | 831-476-1298
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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