Provider Demographics
NPI:1477562148
Name:SANI EYE CENTER, INC.
Entity Type:Organization
Organization Name:SANI EYE CENTER, INC.
Other - Org Name:SANI EYE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-434-2533
Mailing Address - Street 1:1315 LAS TABLAS RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-9759
Mailing Address - Country:US
Mailing Address - Phone:805-434-2533
Mailing Address - Fax:805-434-3037
Practice Address - Street 1:1315 LAS TABLAS RD
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9759
Practice Address - Country:US
Practice Address - Phone:805-434-2533
Practice Address - Fax:805-434-3037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050000434261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA050000434OtherDHS LICENSE NUMBER
CA4183100001OtherDMERC
CAS551039Medicare ID - Type UnspecifiedMEDICARE