Provider Demographics
NPI:1558511881
Name:ADVANCED EYE MEDICAL GROUP A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ADVANCED EYE MEDICAL GROUP A PROFESSIONAL CORPORATION
Other - Org Name:OPHTHALMOLOGY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, PRESIDENT, PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RIBHI
Authorized Official - Middle Name:K
Authorized Official - Last Name:GHOSHEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-582-1090
Mailing Address - Street 1:26701 CROWN VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6356
Mailing Address - Country:US
Mailing Address - Phone:949-582-1090
Mailing Address - Fax:949-582-2892
Practice Address - Street 1:26701 CROWN VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6356
Practice Address - Country:US
Practice Address - Phone:949-582-1090
Practice Address - Fax:949-582-2892
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED EYE MEDICAL GROUP A PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-23
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA035270261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051120Medicare PIN