Basic Information
| Provider Information | |||||||||
| NPI: | 1275585127 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOYCE | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4114 NARRAGANSETT AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192236968 | ||||||||
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| Practice Location | |||||||||
| Address1: | 32245 MISSION TRL | ||||||||
| Address2: | STE D4 | ||||||||
| City: | LAKE ELSINORE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925304528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516741561 | ||||||||
| FaxNumber: | 9516745300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 02/23/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 11833 | CA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | SD118330 | 05 | CA | MEDICAID |