Provider Demographics
NPI:1700052206
Name:TRIANGLE EYE INSTITUTE
Entity Type:Organization
Organization Name:TRIANGLE EYE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-631-2020
Mailing Address - Street 1:5201 CALIFORNIA AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-1673
Mailing Address - Country:US
Mailing Address - Phone:661-631-2020
Mailing Address - Fax:661-631-0370
Practice Address - Street 1:5201 CALIFORNIA AVE STE 410
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-1673
Practice Address - Country:US
Practice Address - Phone:661-631-2020
Practice Address - Fax:661-631-0370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ26227ZMedicare PIN
ZZZ01047ZMedicare PIN
ZZZ26225ZMedicare PIN
ZZZ26229ZMedicare PIN