# EYECARE SPECIALISTS MEDICAL GROUP, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Atlantis Eyecare
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437181930
- **Authorized official:** FELISA MARISOL GALINDO (CREDENTIALING SUPERVISOR)
- **Authorized official phone:** (626) 305-9100

## Contact information

- **Practice address:** 947 S. ANAHEIM BLVD, SUITE 120, ANAHEIM, CA 92805-5590
- **Practice address phone:** (714) 821-4666
- **Practice address fax:** (714) 533-6800
- **Mailing address:** 888 S. DISNEYLAND DRIVE, SUITE 100, ANAHEIM, CA 92802-1828
- **Mailing address phone:** (714) 399-0678
- **Mailing address fax:** (714) 276-6489

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | NULL | — |
| 152W00000X | Optometrist | — | — | — |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/07/2006
- **Last updated:** 11/28/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | W14969E | GROUP NUMBER | CA |