Provider Demographics
NPI:1518142462
Name:ADVANCED EYE CARE & GLAUCOMA CENTER
Entity Type:Organization
Organization Name:ADVANCED EYE CARE & GLAUCOMA CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZAHRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHIASI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-777-5970
Mailing Address - Street 1:113 WATERWORKS WAY STE 245
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3175
Mailing Address - Country:US
Mailing Address - Phone:949-777-5970
Mailing Address - Fax:
Practice Address - Street 1:113 WATERWORKS WAY STE 245
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3175
Practice Address - Country:US
Practice Address - Phone:949-777-5970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA-78525207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1669520490OtherPEROSNAL NPI
CA6228210001Medicare NSC