Provider Demographics
NPI:1598832909
Name:FULLERTON EYE MEDICAL CENTER
Entity Type:Organization
Organization Name:FULLERTON EYE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MOSIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-879-0630
Mailing Address - Street 1:1321 N HARBOR BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4131
Mailing Address - Country:US
Mailing Address - Phone:714-879-3630
Mailing Address - Fax:714-526-2020
Practice Address - Street 1:1321 N HARBOR BLVD STE 300
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4131
Practice Address - Country:US
Practice Address - Phone:714-879-3630
Practice Address - Fax:714-526-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0846370001Medicare NSC