Provider Demographics
NPI:1922238740
Name:CAMERON PARK EYECARE
Entity Type:Organization
Organization Name:CAMERON PARK EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WINNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:530-677-8809
Mailing Address - Street 1:3420 COACH LN
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-8448
Mailing Address - Country:US
Mailing Address - Phone:530-677-8809
Mailing Address - Fax:530-677-7570
Practice Address - Street 1:3420 COACH LN
Practice Address - Street 2:SUITE 1
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8448
Practice Address - Country:US
Practice Address - Phone:530-677-8809
Practice Address - Fax:530-677-7570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11913T332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6231890001Medicare NSC