Provider Demographics
NPI:1902986003
Name:MISSION HILLS EYE CENTER MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:MISSION HILLS EYE CENTER MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RESHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-685-1130
Mailing Address - Street 1:2338 ALMOND AVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2026
Mailing Address - Country:US
Mailing Address - Phone:925-685-1130
Mailing Address - Fax:925-685-1162
Practice Address - Street 1:2338 ALMOND AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2026
Practice Address - Country:US
Practice Address - Phone:925-685-1130
Practice Address - Fax:925-685-1130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG071732174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G717320Medicaid
CAZZZ27899ZMedicare ID - Type Unspecified