Provider Demographics
NPI:1013632009
Name:MCCARTHY OPTOMETRIC GROUP A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MCCARTHY OPTOMETRIC GROUP A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:805-469-5210
Mailing Address - Street 1:99 E DAILY DR
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-5823
Mailing Address - Country:US
Mailing Address - Phone:805-482-8849
Mailing Address - Fax:
Practice Address - Street 1:99 E DAILY DR
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-5823
Practice Address - Country:US
Practice Address - Phone:805-482-8849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-11
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty