Provider Demographics
NPI:1952461600
Name:RAMOS, ERIC (OD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:RAMOS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 E ELDER ST
Mailing Address - Street 2:STE. D
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-3084
Mailing Address - Country:US
Mailing Address - Phone:760-728-9440
Mailing Address - Fax:
Practice Address - Street 1:645 E ELDER ST
Practice Address - Street 2:STE. D
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3084
Practice Address - Country:US
Practice Address - Phone:760-728-9440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT10550T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP10550Medicare PIN
CAU79730Medicare UPIN