MEDICARE: ALAMITOS EYE CARE AN 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	152W00000X	Optometrist	10584T	CA

General Provider Information

NPI Number	:	1881085777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALAMITOS EYE CARE AN OPTOMETRIC CORPORATION

Provider Business Mailing Address
First Line	:	10951 CHERRY ST STE 101
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-2401
Country	:	US
Telephone Number	:	562-430-6161
Fax Number	:

Provider Business Practice Location Address
First Line	:	10951 CHERRY ST STE 101
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-2401
Country	:	US
Telephone Number	:	562-430-6161
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. AVANI PATEL
Credential	:
Telephone Number	:	562-430-6161

Provider Enumeration Date	:	02/12/2015
Last Update Date	:	03/03/2015

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