Provider Demographics
NPI:1093859118
Name:CALIFORNIA EYE CLINIC
Entity Type:Organization
Organization Name:CALIFORNIA EYE CLINIC
Other - Org Name:ROBERT S. GROSSERODE MD & IVAN P. HWANG MD
Other - Org Type:Other Name
Authorized Official - Title/Position:BOOKKEEPING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CREIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-754-2625
Mailing Address - Street 1:1181 CENTRAL BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-2252
Mailing Address - Country:US
Mailing Address - Phone:925-516-0888
Mailing Address - Fax:
Practice Address - Street 1:1181 CENTRAL BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2278
Practice Address - Country:US
Practice Address - Phone:925-516-0894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0657150003Medicare ID - Type Unspecified