Provider Demographics
NPI:1033122957
Name:CLARITY EYE GROUP
Entity Type:Organization
Organization Name:CLARITY EYE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTOINE
Authorized Official - Middle Name:K
Authorized Official - Last Name:FAHD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-842-0651
Mailing Address - Street 1:PO BOX 102407
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91189-2407
Mailing Address - Country:US
Mailing Address - Phone:714-842-0651
Mailing Address - Fax:714-848-7826
Practice Address - Street 1:19671 BEACH BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-5901
Practice Address - Country:US
Practice Address - Phone:714-842-0651
Practice Address - Fax:714-848-7826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 207W00000X
CAA61148207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5737870001Medicare NSC
CAH54877Medicare UPIN
CAH17963Medicare UPIN
CAA32546Medicare UPIN
CAA23251Medicare UPIN
CAA34313Medicare UPIN