Basic Information
| Provider Information | |||||||||
| NPI: | 1063969509 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EYE SPECIALISTS OF CALIFORNIA MEDICAL GROUP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ESCONDIDO OPTICAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1955 CITRACADO PKWY STE 301 | ||||||||
| Address2: | |||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920294113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607463937 | ||||||||
| FaxNumber: | 7607463991 | ||||||||
| Practice Location | |||||||||
| Address1: | 1955 CITRACADO PKWY STE 301 | ||||||||
| Address2: | |||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920294113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607463937 | ||||||||
| FaxNumber: | 7607463991 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2016 | ||||||||
| LastUpdateDate: | 09/02/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SAINI | ||||||||
| AuthorizedOfficialFirstName: | ARVIND | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7607463937 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | EYE SPECIALISTS OF CALIFORNIA MEDICAL GROUP | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 09/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | 179101 | CA | N | Suppliers | Eyewear Supplier (Equipment, not the service) | 207W00000X | A100361 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.