Basic Information
| Provider Information | |||||||||
| NPI: | 1437548708 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UCI OPHTHALMOLOGY GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 51055 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900515355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144562986 | ||||||||
| FaxNumber: | 7144562979 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 THE CITY DR S | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928683201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144562986 | ||||||||
| FaxNumber: | 7144562979 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2015 | ||||||||
| LastUpdateDate: | 01/09/2015 | ||||||||
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| AuthorizedOfficialLastName: | STEINERT | ||||||||
| AuthorizedOfficialFirstName: | ROGER | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9498242020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | REGENTS OF THE UNIVERSITY OF CALIFORNIA | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WC0802X | N | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 332H00000X | N | Suppliers | Eyewear Supplier (Equipment, not the service) | 152W00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.