Organization
CUSTOM EYES OPTOMETRY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL PAUL BOURGOIN O.D. (PRESIDENT)
(949) 646-4949
Entity
Organization
Contact information
Practice address
1835 NEWPORT BLVD, SUITE A-111, COSTA MESA, CA 92627-5031
(949) 646-4949
(949) 646-2533
Mailing address
1835 NEWPORT BLVD, SUITE A-111, COSTA MESA, CA 92627-5031
(949) 646-4949
(949) 646-2533
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
9870T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720197361
INDIVIDUAL NPI
CA
Enumeration date
05/05/2007
Last updated
03/24/2015
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