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General NPI Number Information
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NPI Number | 1730042268
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Entity Type | Organization
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Legal Business Name | DESERT ELITE OPTICAL LLC
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Dates
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Enumeration Date | 12/03/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 45175 PANORAMA DR STE F
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City | PALM DESERT
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State | CA
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Zip | 92260-4482
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Country | US
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Telephone | 760-444-0696
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Fax | 760-444-3223
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Provider Business Mailing Address
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Address Line | 45175 PANORAMA DR STE F
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City | PALM DESERT
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State | CA
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Zip | 92260-4482
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Country | US
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Telephone | 760-444-0696
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Fax | 760-444-3223
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Authorized Official
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Title or Position | PRES
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Name | WALLACE GOLDBAN
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Credential | MD
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Telephone | 760-444-0696
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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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