MEDICARE: EYECARE SPECIALISTS MEDICAL GROUP, 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

General Provider Information

NPI Number	:	1346858537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYECARE SPECIALISTS MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	1595 E 17TH ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-8506
Country	:	US
Telephone Number	:	714-399-0678
Fax Number	:	714-276-6489

Provider Business Practice Location Address
First Line	:	73950 ALESSANDRO DR STE 5
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3637
Country	:	US
Telephone Number	:	760-568-3334
Fax Number	:	760-568-3335

Authorized Official
Title or Position	:	CREDENTIALING SUPERVISOR
Name	:	FELISA MARISOL GALINDO
Credential	:
Telephone Number	:	626-305-9100

Provider Enumeration Date	:	07/14/2020
Last Update Date	:	12/17/2025

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