Provider Demographics
NPI:1265632509
Name:LAGUNA EYES OPTOMETRY PC
Entity Type:Organization
Organization Name:LAGUNA EYES OPTOMETRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER/BIILER
Authorized Official - Prefix:MS
Authorized Official - First Name:SASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-497-1769
Mailing Address - Street 1:1100 S COAST HWY
Mailing Address - Street 2:STE 201
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-2968
Mailing Address - Country:US
Mailing Address - Phone:949-497-1769
Mailing Address - Fax:949-497-2808
Practice Address - Street 1:1100 S COAST HWY
Practice Address - Street 2:STE 201
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2968
Practice Address - Country:US
Practice Address - Phone:949-497-1769
Practice Address - Fax:949-497-2808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB338AMedicare PIN