Provider Demographics
NPI:1902295330
Name:EYEHOME NETWORK OF CALIFORNIA, AN OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:EYEHOME NETWORK OF CALIFORNIA, AN OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-642-2880
Mailing Address - Street 1:1700 W CAMERON AVE
Mailing Address - Street 2:#200
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2718
Mailing Address - Country:US
Mailing Address - Phone:855-528-5642
Mailing Address - Fax:714-371-4188
Practice Address - Street 1:1700 W CAMERON AVE
Practice Address - Street 2:#200
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2718
Practice Address - Country:US
Practice Address - Phone:855-528-5642
Practice Address - Fax:714-371-4188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization