Basic Information
| Provider Information | |||||||||
| NPI: | 1558511881 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED EYE MEDICAL GROUP A PROFESSIONAL CORPORATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | OPHTHALMOLOGY MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26701 CROWN VALLEY PKWY | ||||||||
| Address2: | |||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926916356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495821090 | ||||||||
| FaxNumber: | 9495822892 | ||||||||
| Practice Location | |||||||||
| Address1: | 26701 CROWN VALLEY PKWY | ||||||||
| Address2: | |||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926916356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495821090 | ||||||||
| FaxNumber: | 9495822892 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2008 | ||||||||
| LastUpdateDate: | 04/07/2015 | ||||||||
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| AuthorizedOfficialLastName: | GHOSHEH | ||||||||
| AuthorizedOfficialFirstName: | RIBHI | ||||||||
| AuthorizedOfficialMiddleName: | K. | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR, PRESIDENT, PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 9495821090 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ADVANCED EYE MEDICAL GROUP A PROFESSIONAL CORPORATION | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | A035270 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.