Provider Demographics
NPI:1265515878
Name:EMPIRE EYE AND LASER CENTER INC
Entity type:Organization
Organization Name:EMPIRE EYE AND LASER CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-869-2600
Mailing Address - Street 1:4101 EMPIRE DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0681
Mailing Address - Country:US
Mailing Address - Phone:661-325-3937
Mailing Address - Fax:661-283-3937
Practice Address - Street 1:4101 EMPIRE DR
Practice Address - Street 2:SUITE 120
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0681
Practice Address - Country:US
Practice Address - Phone:661-325-3937
Practice Address - Fax:661-283-3937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZ18298261QM2500X
332B00000X, 152W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0089910Medicaid
CAGR0089910Medicaid
CACH4506Medicare PIN
CA1221790001Medicare NSC