Provider Demographics
NPI:1114061603
Name:SANTA ANA EYECARE OPTOMETRY
Entity Type:Organization
Organization Name:SANTA ANA EYECARE OPTOMETRY
Other - Org Name:SANTA ANA EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-569-1023
Mailing Address - Street 1:1023 N BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-2139
Mailing Address - Country:US
Mailing Address - Phone:714-569-1023
Mailing Address - Fax:714-569-1068
Practice Address - Street 1:1023 N BRISTOL ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-2139
Practice Address - Country:US
Practice Address - Phone:714-569-1023
Practice Address - Fax:714-569-1068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT5836TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0058361Medicaid
CAWY057Medicare ID - Type Unspecified