MEDICARE: HEALTHY EYES MEDICAL GROUP

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		CA

General Provider Information

NPI Number	:	1750540514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY EYES MEDICAL GROUP

Provider Business Mailing Address
First Line	:	816 CAMARILLO SPRINGS RD
Second Line	:	SUITE B
City	:	CAMARILLO
State	:	CA
Zip	:	93012-9441
Country	:	US
Telephone Number	:	805-987-3114
Fax Number	:	805-987-3119

Provider Business Practice Location Address
First Line	:	816 CAMARILLO SPRINGS RD
Second Line	:	SUITE B
City	:	CAMARILLO
State	:	CA
Zip	:	93012-9441
Country	:	US
Telephone Number	:	805-987-3114
Fax Number	:	805-987-3119

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	YOGENDER PAL GARG
Credential	:	MD
Telephone Number	:	805-987-3114

Provider Enumeration Date	:	06/06/2008
Last Update Date	:	05/02/2014

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