Provider Demographics
NPI:1467714311
Name:EYE CARE ASSOCIATES OF SAN DIEGO MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:EYE CARE ASSOCIATES OF SAN DIEGO MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-274-6828
Mailing Address - Street 1:4455 MORENA BLVD.
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4358
Mailing Address - Country:US
Mailing Address - Phone:858-274-6828
Mailing Address - Fax:858-274-6861
Practice Address - Street 1:4455 MORENA BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-4358
Practice Address - Country:US
Practice Address - Phone:858-274-6828
Practice Address - Fax:858-274-6861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty