Provider Demographics
NPI:1952451908
Name:ASSOCIATED CHICO EYE SPECIALISTS
Entity Type:Organization
Organization Name:ASSOCIATED CHICO EYE SPECIALISTS
Other - Org Name:CHICO VISION CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DUDLEY
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-895-3884
Mailing Address - Street 1:85 DECLARATION DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-4902
Mailing Address - Country:US
Mailing Address - Phone:530-895-3884
Mailing Address - Fax:530-343-3030
Practice Address - Street 1:85 DECLARATION DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-4902
Practice Address - Country:US
Practice Address - Phone:530-895-3884
Practice Address - Fax:530-343-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22457207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A224571Medicaid
CA180021131OtherRAILROAD MEDICARE
CA0475230001OtherDMERC
CAA23075Medicare UPIN
CAZZZ37279ZMedicare ID - Type Unspecified