Provider Demographics
NPI:1871792010
Name:EYE MD OF LA JOLLA, APC
Entity type:Organization
Organization Name:EYE MD OF LA JOLLA, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENATA
Authorized Official - Middle Name:
Authorized Official - Last Name:OCHABSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-459-8224
Mailing Address - Street 1:7334 GIRARD AVE
Mailing Address - Street 2:#202
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5141
Mailing Address - Country:US
Mailing Address - Phone:858-459-8224
Mailing Address - Fax:858-459-4062
Practice Address - Street 1:7334 GIRARD AVE
Practice Address - Street 2:#202
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-5141
Practice Address - Country:US
Practice Address - Phone:858-459-8224
Practice Address - Fax:858-459-4062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66153174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH20736Medicare UPIN