Provider Demographics
NPI:1619987666
Name:EYE PHYSICIANS MEDICAL GROUP INC
Entity Type:Organization
Organization Name:EYE PHYSICIANS MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEE ANNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-442-0844
Mailing Address - Street 1:225 WEST MADISON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020
Mailing Address - Country:US
Mailing Address - Phone:619-442-0844
Mailing Address - Fax:619-442-7399
Practice Address - Street 1:225 WEST MADISON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020
Practice Address - Country:US
Practice Address - Phone:619-442-0844
Practice Address - Fax:619-442-7399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ48397ZMedicaid
W412Medicare PIN
CA0442280001Medicare NSC