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General NPI Number Information
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NPI Number | 1689184004
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Entity Type | Organization
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Legal Business Name | ORLANDO CAMACHO, OD, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/11/2017
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Last Update Date | 06/30/2020
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Provider Practice Location Address
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Address Line | 2051 GALLERIA AT TYLER
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City | RIVERSIDE
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State | CA
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Zip | 92503-4143
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Country | US
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Telephone | 951-352-1993
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Fax | 951-352-1195
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Provider Business Mailing Address
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Address Line | 7521 OAKFORD CT
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-8874
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Country | US
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Telephone | 909-899-5317
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OPTOMETRIST
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Name | DR. ORLANDO CAMACHO
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Credential | OD
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Telephone | 951-352-1090
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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 | 9161
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License Number State | CA
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