1811101827 NPI number — DONALD PEARCY & VAN HOOSE OPTOMETRIC CORP., A PARTNERSHIP

Table of content: (NPI 1811101827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811101827 NPI number — DONALD PEARCY & VAN HOOSE OPTOMETRIC CORP., A PARTNERSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DONALD PEARCY & VAN HOOSE OPTOMETRIC CORP., A PARTNERSHIP
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:
1811101827
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
02/03/2009
NPI Reactivation Date:
12/16/2009

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4065 OCEANSIDE BLVD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
OCEANSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92056-5824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-945-2020
Provider Business Mailing Address Fax Number:
760-945-3451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4065 OCEANSIDE BLVD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92056-5824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-945-2020
Provider Business Practice Location Address Fax Number:
760-945-3451
Provider Enumeration Date:
05/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VAN HOOSE
Authorized Official First Name:
MARC
Authorized Official Middle Name:
CAMERON
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
760-560-7501

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  12667 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: 7911T , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: SD0126670 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GSD000640 . This is a "MEDI-CAL GROUP ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: SD0079110 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W18507 . This is a "MEDICARE GROUP ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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