Provider Demographics
NPI:1811101827
Name:DONALD PEARCY & VAN HOOSE OPTOMETRIC CORP., A PARTNERSHIP
Entity type:Organization
Organization Name:DONALD PEARCY & VAN HOOSE OPTOMETRIC CORP., A PARTNERSHIP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:CAMERON
Authorized Official - Last Name:VAN HOOSE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:760-560-7501
Mailing Address - Street 1:4065 OCEANSIDE BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-5824
Mailing Address - Country:US
Mailing Address - Phone:760-945-2020
Mailing Address - Fax:760-945-3451
Practice Address - Street 1:4065 OCEANSIDE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-5824
Practice Address - Country:US
Practice Address - Phone:760-945-2020
Practice Address - Fax:760-945-3451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2009-12-16
Deactivation Date:2009-02-03
Deactivation Code:
Reactivation Date:2009-12-16
Provider Licenses
StateLicense IDTaxonomies
CA7911T152W00000X
CA12667152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0126670Medicaid
CAGSD000640OtherMEDI-CAL GROUP ID
CASD0079110Medicaid
CAW18507OtherMEDICARE GROUP ID
CAWOP12667AMedicare ID - Type UnspecifiedDR. VAN HOOSE MEDICARE
CASD0079110Medicaid
CAU17394Medicare UPIN
CAWOP7911NMedicare ID - Type UnspecifiedDR. PEARCY MEDICARE
CAW18507OtherMEDICARE GROUP ID