Provider Demographics
NPI:1467519470
Name:EYECARE SOLUTIONS INC
Entity Type:Organization
Organization Name:EYECARE SOLUTIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOVENBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-631-3500
Mailing Address - Street 1:477 N EL CAMINO REAL
Mailing Address - Street 2:C202
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024
Mailing Address - Country:US
Mailing Address - Phone:760-631-3500
Mailing Address - Fax:760-753-5150
Practice Address - Street 1:477 N EL CAMINO REAL
Practice Address - Street 2:C202
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024
Practice Address - Country:US
Practice Address - Phone:760-631-3500
Practice Address - Fax:760-753-5150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A41008207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA92582BMedicaid
CAWOP10288BMedicaid
CAWOP12300BMedicaid
A85557Medicare UPIN
CAWOP12300AMedicare ID - Type Unspecified
CAWOP10288BMedicaid
U65999Medicare UPIN
CAWA41008DMedicare ID - Type Unspecified
I15372Medicare UPIN
I28325Medicare UPIN
CAWA92582AMedicare ID - Type Unspecified
CAWOP10288AMedicare ID - Type Unspecified