Provider Demographics
NPI:1316020274
Name:CAMACHO, ORLANDO (OD)
Entity Type:Individual
Prefix:DR
First Name:ORLANDO
Middle Name:
Last Name:CAMACHO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7521 OAKFORD CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-8874
Mailing Address - Country:US
Mailing Address - Phone:909-899-5317
Mailing Address - Fax:
Practice Address - Street 1:2051 GALLERIA AT TYLER
Practice Address - Street 2:INSIDE LENSCRAFTERS
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-9250
Practice Address - Country:US
Practice Address - Phone:951-352-1090
Practice Address - Fax:909-352-1195
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT09161152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0091611Medicaid
CAOPT09161OtherMEDICAL STATE LICENSE
CAWOP9161KMedicare PIN