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Organization
EYECARE SPECIALISTS MEDICAL GROUP, INC.
Active
Organization
EYECARE SPECIALISTS MEDICAL GROUP, INC.
Active
Other names
Atlantis Eyecare
Organization subpart
No
Provider details
NPI number
Authorized official
FELISA MARISOL GALINDO (CREDENTIALING SUPERVISOR)
(626) 305-9100
Entity
Organization
Contact information
Practice address
23521 PASEO DE VALENCIA, SUITE 305, LAGUNA HILLS, CA 92653-3107
(949) 581-1770
(949) 454-2002
Mailing address
888 S DISNEYLAND DR, SUITE 100, ANAHEIM, CA 92802-1847
(714) 399-0678
(714) 276-6489
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
NULL
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
NULL
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ65057Z
BLUE SHIELD
CA
Enumeration date
08/25/2006
Last updated
11/28/2022
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