MEDICARE: RETINA CONSULTANTS OF ORANGE COUNTY, A MEDICAL 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	207WX0107X	Retina Specialist (Ophthalmology) Physician	G32479	CA

General Provider Information

NPI Number	:	1770539702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RETINA CONSULTANTS OF ORANGE COUNTY, A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	301 W BASTANCHURY RD
Second Line	:	285
City	:	FULLERTON
State	:	CA
Zip	:	92835-3419
Country	:	US
Telephone Number	:	714-738-4620
Fax Number	:	714-738-0388

Provider Business Practice Location Address
First Line	:	301 W BASTANCHURY RD
Second Line	:	285
City	:	FULLERTON
State	:	CA
Zip	:	92835-3419
Country	:	US
Telephone Number	:	714-738-4620
Fax Number	:	714-738-0388

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SCOTT GRANT
Credential	:	M.D.
Telephone Number	:	714-738-4620

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	03/04/2022

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