Provider Demographics
NPI:1902880867
Name:ALAN C. WESTEREN, M.D., INC.
Entity Type:Organization
Organization Name:ALAN C. WESTEREN, M.D., INC.
Other - Org Name:EXPERT VISION CARE MEDICAL GROUP, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WESTEREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-354-9833
Mailing Address - Street 1:4629 CASS ST
Mailing Address - Street 2:#59 ALAN WESTEREN MD/EXPERT VISION CARE MEDICAL GROUP
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-2805
Mailing Address - Country:US
Mailing Address - Phone:858-673-2277
Mailing Address - Fax:858-451-3733
Practice Address - Street 1:16486 BERNARDO CENTER DR
Practice Address - Street 2:STE C-150 ALAN C WESTEREN MD INC/EXPERTVISIONCAREMEDGRP
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2518
Practice Address - Country:US
Practice Address - Phone:858-673-2277
Practice Address - Fax:858-451-3733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79738207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G797380Medicaid
CAP00131150OtherRAILROAD MEDICARE NUMBER
CAW18008AOtherMEDICARE POWAY OFFICE
CAW18008OtherMEDICARE COSTA MESA OFFC
CAW18008BOtherMEDICARE SAN DIEGO OFFICE
CAWG79738IMedicare PIN
CAW18008BOtherMEDICARE SAN DIEGO OFFICE
CAW18008AOtherMEDICARE POWAY OFFICE
CA00G797380Medicaid
CAWG79738HMedicare PIN