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General NPI Number Information
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NPI Number | 1801532312
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Entity Type | Organization
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Legal Business Name | ATHENA EYE CARE
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Dates
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Enumeration Date | 05/08/2022
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 26800 CROWN VALLEY PKWY STE 340
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City | MISSION VIEJO
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State | CA
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Zip | 92691-8021
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Country | US
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Telephone | 949-889-2020
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Fax | 949-288-5097
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Provider Business Mailing Address
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Address Line | 15333 CULVER DR STE 340F
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City | IRVINE
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State | CA
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Zip | 92604-3078
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | AUDREY TAI
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Credential | DO
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Telephone | 949-889-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0120X
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Taxonomy Name | Cornea and External Diseases Specialist Physician
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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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