Provider Demographics
NPI:1942501952
Name:MODESTO EYE CENTER INC
Entity Type:Organization
Organization Name:MODESTO EYE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHRAFZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-549-2002
Mailing Address - Street 1:1741 COFFEE RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2807
Mailing Address - Country:US
Mailing Address - Phone:209-549-2002
Mailing Address - Fax:209-549-2004
Practice Address - Street 1:1741 COFFEE RD
Practice Address - Street 2:SUITE #1
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2807
Practice Address - Country:US
Practice Address - Phone:209-549-2002
Practice Address - Fax:209-549-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-07
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79534332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A795340Medicaid
6527380001OtherPTAN
CAH38635Medicare UPIN