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General NPI Number Information
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NPI Number | 1750909065
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Entity Type | Organization
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Legal Business Name | EYECARE SPECIALISTS MEDICAL GROUP, INC
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Dates
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Enumeration Date | 07/13/2020
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 81893 DR CARREON BLVD STE 101
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City | INDIO
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State | CA
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Zip | 92201-0604
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Country | US
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Telephone | 760-396-3600
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Fax | 760-396-5379
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Provider Business Mailing Address
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Address Line | 1595 E 17TH ST
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City | SANTA ANA
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State | CA
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Zip | 92705-8506
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Country | US
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Telephone | 714-399-0678
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Fax | 714-276-6489
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Authorized Official
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Title or Position | CREDENTIALING SUPERVISOR
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Name | FELISA MARISOL GALINDO
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Credential |
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Telephone | 626-305-9100
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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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