Provider Demographics
NPI:1932111473
Name:PRECISION EYE CARE, A MEDICAL CORP CLINIC
Entity Type:Organization
Organization Name:PRECISION EYE CARE, A MEDICAL CORP CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-472-1010
Mailing Address - Street 1:PO BOX 81187
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92138-1187
Mailing Address - Country:US
Mailing Address - Phone:619-472-1010
Mailing Address - Fax:619-472-2092
Practice Address - Street 1:655 EUCLID AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2957
Practice Address - Country:US
Practice Address - Phone:619-472-1010
Practice Address - Fax:619-472-2092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31591174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0057790Medicaid
CAGSD0001350OtherMEDI-CAL OPTICAL
CA0648000001OtherCIGNA-DURABLE EQUIP
CA0648000001OtherCIGNA-DURABLE EQUIP
CA0648000001Medicare NSC
CAW7308Medicare PIN