1902880867 NPI number — ALAN C. WESTEREN, M.D., INC.

Table of content: (NPI 1902880867)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902880867 NPI number — ALAN C. WESTEREN, M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALAN C. WESTEREN, M.D., 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:
EXPERT VISION CARE MEDICAL GROUP, INC.
Provider Other Organization Name Type Code:
3
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:
1902880867
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4629 CASS ST
Provider Second Line Business Mailing Address:
#59 ALAN WESTEREN MD/EXPERT VISION CARE MEDICAL GROUP
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92109-2805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-673-2277
Provider Business Mailing Address Fax Number:
858-451-3733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16486 BERNARDO CENTER DR
Provider Second Line Business Practice Location Address:
STE C-150 ALAN C WESTEREN MD INC/EXPERTVISIONCAREMEDGRP
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92128-2518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-673-2277
Provider Business Practice Location Address Fax Number:
858-451-3733
Provider Enumeration Date:
12/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WESTEREN
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
858-354-9833

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  G79738 , 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: 00G797380 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00131150 . This is a "RAILROAD MEDICARE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: W18008A . This is a "MEDICARE POWAY OFFICE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: W18008 . This is a "MEDICARE COSTA MESA OFFC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: W18008B . This is a "MEDICARE SAN DIEGO OFFICE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com