Provider Demographics
NPI:1992840946
Name:CALIFORNIA EYE CLINIC
Entity Type:Organization
Organization Name:CALIFORNIA EYE CLINIC
Other - Org Name:ROBERT S. GROSSERODE & IVAN P. HWANG
Other - Org Type:Other Name
Authorized Official - Title/Position:BOOKKEEPING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CREIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-754-2300
Mailing Address - Street 1:3747 SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-6101
Mailing Address - Country:US
Mailing Address - Phone:925-754-7100
Mailing Address - Fax:
Practice Address - Street 1:3747 SUNSET LN
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6101
Practice Address - Country:US
Practice Address - Phone:925-754-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0657150002Medicare ID - Type Unspecified
CA0657150003Medicare ID - Type Unspecified
CA0657150001Medicare ID - Type Unspecified