Provider Demographics
NPI:1659519957
Name:ANNELYNN M. CAJAYON OD GROUP
Entity Type:Organization
Organization Name:ANNELYNN M. CAJAYON OD GROUP
Other - Org Name:ANNELYNN M. CAJAYON OD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MAGDATO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:909-621-0979
Mailing Address - Street 1:101 N INDIAN HILL BLVD
Mailing Address - Street 2:SUITE C2-101
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4666
Mailing Address - Country:US
Mailing Address - Phone:909-621-0979
Mailing Address - Fax:909-621-4349
Practice Address - Street 1:101 N INDIAN HILL BLVD
Practice Address - Street 2:SUITE C2-101
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4666
Practice Address - Country:US
Practice Address - Phone:909-621-0979
Practice Address - Fax:909-621-4349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty