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General NPI Number Information
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NPI Number | 1912436593
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Entity Type | Organization
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Legal Business Name | WEST COAST OPTOMETRIC GROUP
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Dates
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Enumeration Date | 06/07/2017
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Last Update Date | 01/10/2020
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Provider Practice Location Address
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Address Line | 27724 SANTA MARGARITA PKWY
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6653
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Country | US
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Telephone | 949-583-0422
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Fax |
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Provider Business Mailing Address
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Address Line | 3038 E STEARNS ST
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City | BREA
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State | CA
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Zip | 92821-4710
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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 | CFO
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Name | DR. ANNA KAME
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Credential | OD
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Telephone | 714-646-9871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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