Provider Demographics
NPI:1689819179
Name:FAMILY EYE HEALTH
Entity Type:Organization
Organization Name:FAMILY EYE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHINN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:760-726-2400
Mailing Address - Street 1:640 ESCONDIDO AVE STE 114
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-6166
Mailing Address - Country:US
Mailing Address - Phone:760-726-2400
Mailing Address - Fax:760-726-2501
Practice Address - Street 1:640 ESCONDIDO AVE STE 114
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-6166
Practice Address - Country:US
Practice Address - Phone:760-726-2400
Practice Address - Fax:760-726-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5373152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0053730Medicaid
CAOP5373Medicare UPIN
CAOP5373Medicare Oscar/Certification
CA0194850002Medicare NSC