Provider Demographics
NPI:1871057786
Name:EYECARE SPECIALISTS MEDICAL GROUP, INC
Entity type:Organization
Organization Name:EYECARE SPECIALISTS MEDICAL GROUP, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:FELISA
Authorized Official - Middle Name:MARISOL
Authorized Official - Last Name:GALINDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-305-9100
Mailing Address - Street 1:14726 RAMONA AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5730
Mailing Address - Country:US
Mailing Address - Phone:626-305-9100
Mailing Address - Fax:626-305-0152
Practice Address - Street 1:229 E BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3776
Practice Address - Country:US
Practice Address - Phone:323-647-3350
Practice Address - Fax:323-874-4368
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYECARE SPECIALISTS MEDICAL GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-24
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical