Provider Demographics
NPI:1477519205
Name:OMENS, ERWIN M (MD)
Entity Type:Individual
Prefix:
First Name:ERWIN
Middle Name:M
Last Name:OMENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 EAST OHIO AVENUE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3421
Mailing Address - Country:US
Mailing Address - Phone:760-745-9500
Mailing Address - Fax:760-746-3991
Practice Address - Street 1:810 EAST OHIO AVENUE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3421
Practice Address - Country:US
Practice Address - Phone:760-745-9500
Practice Address - Fax:760-746-3991
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38629207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG38629Medicare ID - Type Unspecified
A92011Medicare UPIN