1285823138 NPI number — EYEMAX OPTOMETRY INC

Table of content: (NPI 1285823138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285823138 NPI number — EYEMAX OPTOMETRY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYEMAX OPTOMETRY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285823138
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2097 N TUSTIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92865-3901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-637-9999
Provider Business Mailing Address Fax Number:
714-637-9993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2097 N TUSTIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92865-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-637-9999
Provider Business Practice Location Address Fax Number:
714-637-9993
Provider Enumeration Date:
10/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
METSOVAS
Authorized Official First Name:
TERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/ PRESIDENT
Authorized Official Telephone Number:
714-637-9999

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  10460T , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5302020001 . This is a "MEDICARE DEMERC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 61327 . This is a "SAFEGUARD PPO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 9358503 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: SD0104600 . This is a "CAL-OPTIMA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: SD01046T1 . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 61328 . This is a "SAFEGUARD HMO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: M134935 . This is a "INTEGRATED HEALTHPLAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 13607 . This is a "MEDICAL EYE SERVICES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: SD0104600 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 207199 . This is a "EYEMED" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CA10460 . This is a "VISION BENEFITS OF AMERIC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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