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General NPI Number Information
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NPI Number | 1871057786
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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 | 01/24/2019
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 229 E BEVERLY BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-3776
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Country | US
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Telephone | 323-647-3350
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Fax | 323-874-4368
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Provider Business Mailing Address
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Address Line | 14726 RAMONA AVE STE 203
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City | CHINO
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State | CA
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Zip | 91710-5730
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Country | US
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Telephone | 626-305-9100
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Fax | 626-305-0152
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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 | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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