Provider Demographics
NPI:1285823138
Name:EYEMAX OPTOMETRY INC
Entity Type:Organization
Organization Name:EYEMAX OPTOMETRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:METSOVAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-637-9999
Mailing Address - Street 1:2097 N TUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-3901
Mailing Address - Country:US
Mailing Address - Phone:714-637-9999
Mailing Address - Fax:714-637-9993
Practice Address - Street 1:2097 N TUSTIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-3901
Practice Address - Country:US
Practice Address - Phone:714-637-9999
Practice Address - Fax:714-637-9993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10460T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5302020001OtherMEDICARE DEMERC
CA61327OtherSAFEGUARD PPO
CA9358503OtherPRIVATE HEALTHCARE SYSTEM
CASD0104600OtherCAL-OPTIMA
CASD01046T1OtherBLUE SHIELD
CA61328OtherSAFEGUARD HMO
CAM134935OtherINTEGRATED HEALTHPLAN
CA13607OtherMEDICAL EYE SERVICES
CASD0104600Medicaid
CA207199OtherEYEMED
CACA10460OtherVISION BENEFITS OF AMERIC
CA9358503OtherPRIVATE HEALTHCARE SYSTEM
CACA10460OtherVISION BENEFITS OF AMERIC