Provider Demographics
NPI:1770243891
Name:DEL MAR OPTOMETRIC GROUP
Entity Type:Organization
Organization Name:DEL MAR OPTOMETRIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:DEXTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:858-945-4023
Mailing Address - Street 1:8758 DENT CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-1406
Mailing Address - Country:US
Mailing Address - Phone:858-945-4023
Mailing Address - Fax:
Practice Address - Street 1:1349 CAMINO DEL MAR STE C
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2553
Practice Address - Country:US
Practice Address - Phone:548-485-8755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty