Provider Demographics
NPI:1225102874
Name:EYE CARE INSTITUTE, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:EYE CARE INSTITUTE, A MEDICAL CORPORATION
Other - Org Name:EYE CARE INSTITUTE, OPTICAL DISPENSARY
Other - Org Type:Other Name
Authorized Official - Title/Position:CORPORATION PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-546-9800
Mailing Address - Street 1:720 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4421
Mailing Address - Country:US
Mailing Address - Phone:707-763-6400
Mailing Address - Fax:707-528-4967
Practice Address - Street 1:1017 2ND ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-6608
Practice Address - Country:US
Practice Address - Phone:707-546-9800
Practice Address - Fax:707-546-4112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0399240001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ76363ZMedicaid
00G343820Medicare PIN
A45905Medicare UPIN
0399240001Medicare NSC
CA180042403Medicare PIN
CA180014574Medicare PIN
F13493Medicare UPIN
CAZZZ76363ZMedicaid
CA180014573Medicare PIN
CASD0098570Medicare PIN
CA180036143Medicare PIN
CAZZZ76363ZMedicare PIN
00G493740Medicare PIN
F12164Medicare UPIN
CA00G608280Medicare PIN
A51347Medicare UPIN
CA410043804Medicare PIN
CACS5700Medicare PIN
CA00G620850Medicare PIN