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General NPI Number Information
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NPI Number | 1619973591
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Entity Type | Organization
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Legal Business Name | ALVARADO EYE ASSOCIATES MED CLINIC INC
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Dates
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Enumeration Date | 06/24/2005
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 7877 PARKWAY DR. SUITE# 100
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City | LA MESA
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State | CA
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Zip | 91942-2000
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Country | US
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Telephone | 619-460-3711
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Fax | 619-460-2184
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Provider Business Mailing Address
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Address Line | 75 ENTERPRISE STE 200
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City | ALISO VIEJO
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State | CA
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Zip | 92656-2626
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Country | US
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Telephone | 949-688-6205
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Fax | 619-460-2184
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Authorized Official
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Title or Position | OWNER
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Name | MR. GLEN COOK
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Credential | MD
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Telephone | 619-460-3711
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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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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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