Provider Demographics
NPI:1881983716
Name:NEWPORT CENTER EYE SPECIALISTS, A MEDICAL CORPORATION
Entity type:Organization
Organization Name:NEWPORT CENTER EYE SPECIALISTS, A MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:DORIANNE
Authorized Official - Last Name:GARBUTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-640-2023
Mailing Address - Street 1:400 NEWPORT CENTER DR STE 404
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7687
Mailing Address - Country:US
Mailing Address - Phone:949-640-2023
Mailing Address - Fax:949-640-7182
Practice Address - Street 1:400 NEWPORT CENTER DR STE 404
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7687
Practice Address - Country:US
Practice Address - Phone:949-640-2023
Practice Address - Fax:949-640-7182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG24340Medicare UPIN