Provider Demographics
NPI:1922027176
Name:SAN DIEGO EYECOR LLC
Entity Type:Organization
Organization Name:SAN DIEGO EYECOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BOKOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-765-2737
Mailing Address - Street 1:3939 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3002
Mailing Address - Country:US
Mailing Address - Phone:800-765-2737
Mailing Address - Fax:619-291-6577
Practice Address - Street 1:3939 3RD AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3002
Practice Address - Country:US
Practice Address - Phone:619-296-8525
Practice Address - Fax:619-692-0229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051011AMedicare PIN