Basic Information
| Provider Information | |||||||||
| NPI: | 1780669283 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORTON | ||||||||
| FirstName: | ASA | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3939 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921033002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192968525 | ||||||||
| FaxNumber: | 6196920229 | ||||||||
| Practice Location | |||||||||
| Address1: | 3939 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921033002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192968525 | ||||||||
| FaxNumber: | 6196920229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2005 | ||||||||
| LastUpdateDate: | 07/31/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | G68919 | CA | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207WX0200X | G68919 | CA | Y |
ID Information
| ID | Type | State | Issuer | Description | GR0092690 | 05 | CA | MEDICAID |