Provider Demographics
NPI:1093947053
Name:ENCINITAS OPTOMETRY INC.
Entity Type:Organization
Organization Name:ENCINITAS OPTOMETRY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:760-436-1877
Mailing Address - Street 1:681 ENCINITAS BLVD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3762
Mailing Address - Country:US
Mailing Address - Phone:760-436-1877
Mailing Address - Fax:760-632-7319
Practice Address - Street 1:681 ENCINITAS BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3762
Practice Address - Country:US
Practice Address - Phone:760-436-1877
Practice Address - Fax:760-632-7319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-10
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT8966TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT8966TPAOtherCA LICENSE
CAOP8966Medicare PIN
CH431AMedicare PIN