Provider Demographics
NPI:1922103688
Name:CARMEL MOUNTAIN VISION CARE, INC
Entity Type:Organization
Organization Name:CARMEL MOUNTAIN VISION CARE, INC
Other - Org Name:CARMEL MOUNTAIN VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:REEDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:858-484-1500
Mailing Address - Street 1:9320 CARMEL MOUNTAIN RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2159
Mailing Address - Country:US
Mailing Address - Phone:858-484-1500
Mailing Address - Fax:858-484-9143
Practice Address - Street 1:9320 CARMEL MOUNTAIN RD
Practice Address - Street 2:SUITE E
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2159
Practice Address - Country:US
Practice Address - Phone:858-484-1500
Practice Address - Fax:858-484-9143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6425T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19290AMedicare PIN