MEDICARE: ALVARADO EYE ASSOCIATES MED CLINIC 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	G063727	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0802380003	OTHER	CA	MEDICARE DME

Other Identifiers

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

General Provider Information

NPI Number	:	1275709503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALVARADO EYE ASSOCIATES MED CLINIC INC.

Provider Business Mailing Address
First Line	:	7877 PARKWAY DR
Second Line	:	SUITE 100
City	:	LA MESA
State	:	CA
Zip	:	91942-2000
Country	:	US
Telephone Number	:	619-286-3711
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 ORANGE AVE
Second Line	:	SUITE 204
City	:	CORONADO
State	:	CA
Zip	:	92118-2663
Country	:	US
Telephone Number	:	619-437-4406
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GLENN B COOK
Credential	:	MD
Telephone Number	:	619-286-3712

Provider Enumeration Date	:	05/06/2008
Last Update Date	:	04/29/2013

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