Provider Demographics
NPI:1336313121
Name:HEMET EYE CARE CENTER OF OPTOMETRY
Entity Type:Organization
Organization Name:HEMET EYE CARE CENTER OF OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:951-929-2746
Mailing Address - Street 1:999 E MORTON PL
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4534
Mailing Address - Country:US
Mailing Address - Phone:951-929-2746
Mailing Address - Fax:951-925-7041
Practice Address - Street 1:999 E MORTON PL
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4534
Practice Address - Country:US
Practice Address - Phone:951-929-2746
Practice Address - Fax:951-925-7041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD004570Medicaid
CAGSD004570Medicaid