Provider Demographics
NPI:1164529160
Name:CLEARVIEW EYE & LASER MEDICAL CENTER A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CLEARVIEW EYE & LASER MEDICAL CENTER A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:T
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-452-3937
Mailing Address - Street 1:PO BOX 2530
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-1830
Mailing Address - Country:US
Mailing Address - Phone:858-452-3937
Mailing Address - Fax:858-452-3933
Practice Address - Street 1:6255 LUSK BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3763
Practice Address - Country:US
Practice Address - Phone:858-452-3937
Practice Address - Fax:858-452-3933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57688207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALICENSEOtherG57688
CALICENSEOtherG57688
CAF02062Medicare UPIN