Provider Demographics
NPI:1629133178
Name:MONTEREY BAY EYE ASSOCIATES MEDICAL GROUP, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MONTEREY BAY EYE ASSOCIATES MEDICAL GROUP, A MEDICAL CORPORATION
Other - Org Name:MONTEREY COUNTY EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL PIERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-424-1150
Mailing Address - Street 1:1441 CONSTITUTION BLVD
Mailing Address - Street 2:BLDG 400 STE 100
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-3100
Mailing Address - Country:US
Mailing Address - Phone:831-424-1150
Mailing Address - Fax:831-424-1158
Practice Address - Street 1:1441 CONSTITUTION BLVD
Practice Address - Street 2:BLDG 400 STE 100
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3100
Practice Address - Country:US
Practice Address - Phone:831-424-1150
Practice Address - Fax:831-424-1158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46085207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0083340Medicaid
CAZZZ15040ZMedicare PIN