Provider Demographics
NPI:1427577907
Name:ADVANCE OC SURGICAL INC.
Entity Type:Organization
Organization Name:ADVANCE OC SURGICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:OMID
Authorized Official - Last Name:ROHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:949-212-7133
Mailing Address - Street 1:3500 S. BRISTOL ST.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704
Mailing Address - Country:US
Mailing Address - Phone:714-557-0777
Mailing Address - Fax:714-557-0709
Practice Address - Street 1:3500 S. BRISTOL ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704
Practice Address - Country:US
Practice Address - Phone:714-557-0777
Practice Address - Fax:714-557-0709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical