MEDICARE: EYE AND VISION CENTRAL CALIFORNIA INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	A80829	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CC054B	OTHER	CA	MEDICARE

General Provider Information

NPI Number	:	1134365679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE AND VISION CENTRAL CALIFORNIA INC

Provider Business Mailing Address
First Line	:	2325 W CLEVELAND AVE
Second Line	:	STE 103
City	:	MADERA
State	:	CA
Zip	:	93637-8753
Country	:	US
Telephone Number	:	559-674-4700
Fax Number	:

Provider Business Practice Location Address
First Line	:	2325 W CLEVELAND AVE
Second Line	:	STE 103
City	:	MADERA
State	:	CA
Zip	:	93637-8753
Country	:	US
Telephone Number	:	559-674-4700
Fax Number	:	559-674-3900

Authorized Official
Title or Position	:	PRESDENT
Name	:	NING LIN
Credential	:	M.D.
Telephone Number	:	559-674-4700

Provider Enumeration Date	:	01/06/2009
Last Update Date	:	02/07/2013

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