Provider Demographics
NPI:1609353317
Name:OC OPTOMETRY GROUP, INC.
Entity Type:Organization
Organization Name:OC OPTOMETRY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAWAA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:562-276-8080
Mailing Address - Street 1:1000 BRISTOL ST N STE 29
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-8917
Mailing Address - Country:US
Mailing Address - Phone:562-276-8080
Mailing Address - Fax:949-476-3087
Practice Address - Street 1:1000 BRISTOL ST N STE 29
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-8917
Practice Address - Country:US
Practice Address - Phone:562-276-8080
Practice Address - Fax:949-476-3087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13797152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty