Provider Demographics
NPI:1780190561
Name:BALDWIN PARK EYE CARE PA
Entity Type:Organization
Organization Name:BALDWIN PARK EYE CARE PA
Other - Org Name:BALDWIN PARK EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIASGHAR
Authorized Official - Middle Name:MEHEBOOB
Authorized Official - Last Name:JAGANI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-979-4829
Mailing Address - Street 1:4829 NEW BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6629
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4829 NEW BROAD ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814-6629
Practice Address - Country:US
Practice Address - Phone:407-979-4829
Practice Address - Fax:407-369-4250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-15
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty