Provider Demographics
NPI:1437789294
Name:PACIFIC PARTNERS OPTOMETRIC GROUP INC
Entity Type:Organization
Organization Name:PACIFIC PARTNERS OPTOMETRIC GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARELLANO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-448-7166
Mailing Address - Street 1:17451 BASTANCHURY RD STE 104C-1
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-1857
Mailing Address - Country:US
Mailing Address - Phone:714-448-7166
Mailing Address - Fax:714-992-8020
Practice Address - Street 1:17451 BASTANCHURY RD STE 104C-1
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-1857
Practice Address - Country:US
Practice Address - Phone:714-448-7166
Practice Address - Fax:714-992-8020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty