1912043605 NPI number — COCKERHAM EYE CONSULTANTS PROFESSIONAL CORPORATION

Table of content: MS. CAROL LOVELETT ED.M., LCPC (NPI 1659348704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912043605 NPI number — COCKERHAM EYE CONSULTANTS PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COCKERHAM EYE CONSULTANTS PROFESSIONAL CORPORATION
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:
6
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:
1912043605
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23052 ALICIA PKWY STE 619
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSION VIEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92692-1643
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
657-284-2178
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3590 CAMINO DEL RIO N STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-1707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-810-1275
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COCKERHAM
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
408-873-7801

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  G86885 , 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)





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