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 OD (CEO)
(805) 925-2637
Entity
Organization
Contact information
Practice address
2040 VIBORG RD, #240, SOLVANG, CA 93463
(805) 688-0707
(805) 693-9839
Mailing address
910 E STOWELL RD, SANTA MARIA, CA 93454-7001
(805) 925-2637
(805) 347-0033
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT5812TPG
CA
207W00000X
Ophthalmology Physician
G71086
CA
207W00000X
Ophthalmology Physician
—
—
Other
Enumeration date
01/20/2014
Last updated
10/01/2018
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