Provider Demographics
NPI:1003968017
Name:ADVANCED EYE MEDICAL GROUP A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ADVANCED EYE MEDICAL GROUP A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RIBHI
Authorized Official - Middle Name:K
Authorized Official - Last Name:GHOSHEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-582-1090
Mailing Address - Street 1:26701 CROWN VALLEY PARKWAY
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691
Mailing Address - Country:US
Mailing Address - Phone:949-582-1090
Mailing Address - Fax:
Practice Address - Street 1:26701 CROWN VALLEY PARKWAY
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-582-1090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW8367Medicare PIN