Provider Demographics
NPI:1477264901
Name:ELITE EYECARE MEDICAL GROUP A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ELITE EYECARE MEDICAL GROUP A MEDICAL CORPORATION
Other - Org Name:MORRO BAY OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHRIAR
Authorized Official - Middle Name:RAMI
Authorized Official - Last Name:ZARNEGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-925-2637
Mailing Address - Street 1:910 E STOWELL RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7001
Mailing Address - Country:US
Mailing Address - Phone:805-925-2637
Mailing Address - Fax:
Practice Address - Street 1:590 HARBOR ST
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-1904
Practice Address - Country:US
Practice Address - Phone:805-772-1269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty