Provider Demographics
NPI:1659857928
Name:ELITE EYECARE MEDICAL GROUP A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ELITE EYECARE MEDICAL GROUP A MEDICAL CORPORATION
Other - Org Name:SANTA YNEZ VALLEY OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNEHT
Authorized Official - Middle Name:
Authorized Official - Last Name:KENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:805-925-2637
Mailing Address - Street 1:910 E STOWELL RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7001
Mailing Address - Country:US
Mailing Address - Phone:805-925-2637
Mailing Address - Fax:805-614-7718
Practice Address - Street 1:2040 VIBORG RD STE 240
Practice Address - Street 2:
Practice Address - City:SOLVANG
Practice Address - State:CA
Practice Address - Zip Code:93463
Practice Address - Country:US
Practice Address - Phone:805-688-0707
Practice Address - Fax:805-693-9839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier