Organization
MODESTO EYE CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMIN ASHRAFZADEH MD (PRESIDENT)
(209) 549-2002
Entity
Organization
Contact information
Practice address
1741 COFFEE RD, SUITE #1, MODESTO, CA 95355-2807
(209) 549-2002
(209) 549-2004
Mailing address
1741 COFFEE RD, SUITE #1, MODESTO, CA 95355-2807
(209) 549-2002
(209) 549-2004
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
A79534
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A795340
—
CA
01
—
6527380001
PTAN
—
Enumeration date
11/07/2010
Last updated
09/28/2011
Update your record
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