MEDICARE: ADVANCED EYECARE ASSOCIATES 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	152W00000X	Optometrist	OPT9569TPG	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235598830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED EYECARE ASSOCIATES INC

Provider Business Mailing Address
First Line	:	1028 6TH ST
Second Line	:
City	:	LOS BANOS
State	:	CA
Zip	:	93635-4218
Country	:	US
Telephone Number	:	209-826-1434
Fax Number	:

Provider Business Practice Location Address
First Line	:	1028 6TH ST
Second Line	:
City	:	LOS BANOS
State	:	CA
Zip	:	93635-4218
Country	:	US
Telephone Number	:	209-826-1434
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TRAJAN JOAQUIN SOARES
Credential	:	O.D.
Telephone Number	:	209-826-1434

Provider Enumeration Date	:	02/11/2016
Last Update Date	:	02/11/2016

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