Provider Demographics
NPI:1275954372
Name:SAN DIEGO CENTER FOR VISION CARE
Entity Type:Organization
Organization Name:SAN DIEGO CENTER FOR VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:HILLIER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:619-464-7713
Mailing Address - Street 1:7898 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-1801
Mailing Address - Country:US
Mailing Address - Phone:619-464-7713
Mailing Address - Fax:619-464-7668
Practice Address - Street 1:7898 BROADWAY
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-1801
Practice Address - Country:US
Practice Address - Phone:619-464-7713
Practice Address - Fax:619-464-7668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA04268152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty