Provider Demographics
NPI:1497956585
Name:EDGAR C AGUILAR O D INC
Entity Type:Organization
Organization Name:EDGAR C AGUILAR O D INC
Other - Org Name:ADVANCED EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROBLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-352-3505
Mailing Address - Street 1:2151 ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-3685
Mailing Address - Country:US
Mailing Address - Phone:760-352-3505
Mailing Address - Fax:760-352-3046
Practice Address - Street 1:2151 ROSS AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3685
Practice Address - Country:US
Practice Address - Phone:760-352-3505
Practice Address - Fax:760-352-3046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12273T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU02562Medicare UPIN