Provider Demographics
NPI:1235501321
Name:FAMILY OPTOMETRIC ASSOCIATES OF CALIFORNIA, INC.
Entity Type:Organization
Organization Name:FAMILY OPTOMETRIC ASSOCIATES OF CALIFORNIA, INC.
Other - Org Name:FAMILY OPTOMETRIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHADO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:240-405-8244
Mailing Address - Street 1:2260 CALLAHAN HWY
Mailing Address - Street 2:BLDG 3187-A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92136
Mailing Address - Country:US
Mailing Address - Phone:619-550-2679
Mailing Address - Fax:
Practice Address - Street 1:2260 CALLAHAN HWY
Practice Address - Street 2:BLDG 3187-A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92136
Practice Address - Country:US
Practice Address - Phone:619-550-2679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15408152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty