Basic Information
| Provider Information | |||||||||
| NPI: | 1629133178 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONTEREY BAY EYE ASSOCIATES MEDICAL GROUP, A MEDICAL CORPORATION | ||||||||
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| OtherOrganizationName: | MONTEREY COUNTY EYE ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1441 CONSTITUTION BLVD | ||||||||
| Address2: | BLDG 400 STE 100 | ||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939063100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314241150 | ||||||||
| FaxNumber: | 8314241158 | ||||||||
| Practice Location | |||||||||
| Address1: | 1441 CONSTITUTION BLVD | ||||||||
| Address2: | BLDG 400 STE 100 | ||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939063100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314241150 | ||||||||
| FaxNumber: | 8314241158 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2006 | ||||||||
| LastUpdateDate: | 06/25/2013 | ||||||||
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| AuthorizedOfficialLastName: | DEL PIERO | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8314241150 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | G46085 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | GR0083340 | 05 | CA | MEDICAID |