MEDICARE: UPTOWN EYE ASSOCIATES A PROFESSIONAL OPTOMETRIC CORPORATION

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	152WC0802X	Corneal and Contact Management Optometrist

General Provider Information

NPI Number	:	1689568115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPTOWN EYE ASSOCIATES A PROFESSIONAL OPTOMETRIC CORPORATION

Provider Business Mailing Address
First Line	:	4096 PARK BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2620
Country	:	US
Telephone Number	:	619-291-5505
Fax Number	:

Provider Business Practice Location Address
First Line	:	4096 PARK BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2620
Country	:	US
Telephone Number	:	619-291-5505
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	CATHERINE SPADY
Credential	:
Telephone Number	:	503-560-2252

Provider Enumeration Date	:	06/09/2025
Last Update Date	:	06/11/2025

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