Provider Demographics
NPI:1003361270
Name:IGNE OPTOMETRIC CORPORATION
Entity type:Organization
Organization Name:IGNE OPTOMETRIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:IGNE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:949-733-1400
Mailing Address - Street 1:4950 BARRANCA PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4630
Mailing Address - Country:US
Mailing Address - Phone:949-733-1400
Mailing Address - Fax:949-559-8984
Practice Address - Street 1:4950 BARRANCA PKWY STE 101
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4630
Practice Address - Country:US
Practice Address - Phone:949-733-1400
Practice Address - Fax:949-559-8984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152WP0200X, 152WV0400X, 152WV0400X
CAOPT14967TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14967TLGOtherCA STATE BOARD OF OPTOMETRY