# EYECARE SPECIALISTS MEDICAL GROUP, INC.

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

## Provider details

- **NPI number:** 1487762159
- **Authorized official:** FELISA MARISOL GALINDO (CREDENTIALING SUPERVISOR)
- **Authorized official phone:** (626) 305-9100

## Contact information

- **Practice address:** 23521 PASEO DE VALENCIA, SUITE 305, LAGUNA HILLS, CA 92653-3107
- **Practice address phone:** (949) 581-1770
- **Practice address fax:** (949) 454-2002
- **Mailing address:** 888 S DISNEYLAND DR, SUITE 100, ANAHEIM, CA 92802-1847
- **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:** 08/25/2006
- **Last updated:** 11/28/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | ZZZ65057Z | BLUE SHIELD | CA |