Provider Demographics
NPI:1770668717
Name:FUCHS, MIRIAM BELTRAN (OD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:BELTRAN
Last Name:FUCHS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 ALAMO LN
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-7650
Mailing Address - Country:US
Mailing Address - Phone:619-587-4427
Mailing Address - Fax:760-631-7915
Practice Address - Street 1:1800 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-7700
Practice Address - Country:US
Practice Address - Phone:760-631-7914
Practice Address - Fax:760-631-7915
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 12992 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist