Organization
PENINSULA EYE SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY M FIELDS (VP)
(205) 545-2572
Entity
Organization
Contact information
Practice address
1128 W EL CAMINO REAL, MOUNTAIN VIEW, CA 94040-2518
(650) 964-3200
(650) 964-3206
Mailing address
1128 W EL CAMINO REAL, MOUNTAIN VIEW, CA 94040-2518
(650) 964-3200
(650) 964-3206
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
—
—
261QS0132X
Ophthalmologic Surgery Clinic/Center
Primary
550000072
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AS1737
BLUE CROSS
—
05
—
SUR01737F
—
CA
Enumeration date
11/07/2006
Last updated
08/21/2014
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