Provider Demographics
NPI:1033199575
Name:FIMBRES, EDMUNDO CHARLES (OD)
Entity Type:Individual
Prefix:
First Name:EDMUNDO
Middle Name:CHARLES
Last Name:FIMBRES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 HILBY AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955-5339
Mailing Address - Country:US
Mailing Address - Phone:831-899-2020
Mailing Address - Fax:
Practice Address - Street 1:915 HILBY AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-5339
Practice Address - Country:US
Practice Address - Phone:831-899-2020
Practice Address - Fax:831-899-5504
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6655T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGROOO1660Medicaid
CAT10387Medicare UPIN
CASD0066550Medicare ID - Type Unspecified