Organization
ALVARADO EYE ASSOCIATES MED CLINIC INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLENN B COOK MD (OWNER)
(619) 286-3712
Entity
Organization
Contact information
Practice address
801 ORANGE AVE, SUITE 204, CORONADO, CA 92118-2663
(619) 437-4406
Mailing address
7877 PARKWAY DR, SUITE 100, LA MESA, CA 91942-2000
(619) 286-3711
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
G063727
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0802380003
MEDICARE DME
CA
05
—
GR0078470
—
CA
Enumeration date
05/06/2008
Last updated
04/29/2013
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