Provider Demographics
NPI:1538463450
Name:EYECARE ONE
Entity Type:Organization
Organization Name:EYECARE ONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:909-592-5666
Mailing Address - Street 1:963 W ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2410
Mailing Address - Country:US
Mailing Address - Phone:909-592-5666
Mailing Address - Fax:909-394-3334
Practice Address - Street 1:963 W ARROW HWY
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2410
Practice Address - Country:US
Practice Address - Phone:909-592-5666
Practice Address - Fax:909-394-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 9068 TPA305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization