Provider Demographics
NPI:1548214497
Name:ADVANCED EYECARE CENTER, INC.
Entity type:Organization
Organization Name:ADVANCED EYECARE CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:T
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-965-0300
Mailing Address - Street 1:19582 BEACH BLVD
Mailing Address - Street 2:#102
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-2996
Mailing Address - Country:US
Mailing Address - Phone:714-965-0300
Mailing Address - Fax:
Practice Address - Street 1:19582 BEACH BLVD
Practice Address - Street 2:#102
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2996
Practice Address - Country:US
Practice Address - Phone:714-965-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74216174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265402788OtherINDIVIDUAL NPI
CAI33674Medicare UPIN