Provider Demographics
NPI:1114411782
Name:CYPRESS OPHTHALMOLOGY GROUP INC.
Entity Type:Organization
Organization Name:CYPRESS OPHTHALMOLOGY GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER NETWORK MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEAHANN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-448-2782
Mailing Address - Street 1:163 W VENTURA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-8373
Mailing Address - Country:US
Mailing Address - Phone:215-206-9533
Mailing Address - Fax:
Practice Address - Street 1:14675 RINALDI ST STE EANDF
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-4190
Practice Address - Country:US
Practice Address - Phone:818-675-9864
Practice Address - Fax:818-361-2133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty