Provider Demographics
NPI:1043345051
Name:ADVANCED EYE ASSOCIATES
Entity Type:Organization
Organization Name:ADVANCED EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-923-8138
Mailing Address - Street 1:200 JOSE FIGUERES AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1585
Mailing Address - Country:US
Mailing Address - Phone:408-923-8138
Mailing Address - Fax:408-923-8214
Practice Address - Street 1:200 JOSE FIGUERES AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1585
Practice Address - Country:US
Practice Address - Phone:408-923-8138
Practice Address - Fax:408-923-8214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT12726152W00000X
CAOPT12795152WL0500X
CA00G805732207W00000X
CA5797900001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD005300Medicaid
CA5797900001Medicare NSC