Provider Demographics
NPI:1164497905
Name:HERITAGE VALLEY EYE CARE OPTOMETRIC CENTER
Entity Type:Organization
Organization Name:HERITAGE VALLEY EYE CARE OPTOMETRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:M
Authorized Official - Last Name:LUEKENGA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:805-525-6603
Mailing Address - Street 1:400 E SANTA BARBARA ST
Mailing Address - Street 2:STE C
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-2675
Mailing Address - Country:US
Mailing Address - Phone:805-525-6603
Mailing Address - Fax:805-525-6115
Practice Address - Street 1:400 E SANTA BARBARA ST
Practice Address - Street 2:STE C
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-2675
Practice Address - Country:US
Practice Address - Phone:805-525-6603
Practice Address - Fax:805-525-6115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACOR618152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD000080Medicaid
CAGSD000080Medicaid
CAWY2092Medicare PIN