=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831481431
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BARRETT HUNTER EUBANKS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2011
-----------------------------------------------------
Last Update Date | 10/30/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25485 MEDICAL CENTER DR STE 212
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92562-6927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-417-1607
-----------------------------------------------------
Fax | 951-696-4249
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 75 ENTERPRISE STE 200
-----------------------------------------------------
City | ALISO VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92656-2626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-308-7537
-----------------------------------------------------
Fax | 949-243-7467
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | ME124435
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------