Provider Demographics
NPI:1942858071
Name:EYEDEOLOGY OPTOMETRY OF MISSION VIEJO
Entity Type:Organization
Organization Name:EYEDEOLOGY OPTOMETRY OF MISSION VIEJO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:DARRELL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:949-290-2286
Mailing Address - Street 1:145 VIA MURCIA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-3859
Mailing Address - Country:US
Mailing Address - Phone:949-290-2286
Mailing Address - Fax:949-364-4001
Practice Address - Street 1:30 THE SHOPS AT MISSION VIEJO
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6527
Practice Address - Country:US
Practice Address - Phone:949-364-4004
Practice Address - Fax:949-364-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-02
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty