Organization
ELITE EYECARE MEDICAL GROUP A MEDICAL CORPORATION
Active
Other names
SHEPARD EYE CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH R KENDALL O.D (CEO)
(805) 922-2637
Entity
Organization
Contact information
Practice address
1429 S BROADWAY, SANTA MARIA, CA 93454
(805) 925-9575
(805) 347-0033
Mailing address
910 E STOWELL RD, SANTA MARIA, CA 93454-7001
(805) 925-2637
(805) 347-0033
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0086921
—
CA
Enumeration date
09/15/2010
Last updated
10/01/2018
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